(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "Towards a theology of personhood : the gift of the Alzheimer Christian as a way of re-connecting ourselves to God, through which the reclaiming of the gifts of the church can assist us"

EPISCOPAL DIVINITY SCHOOL 



Thesis/Project 



TOWARDS A THEOLOGY OF PERSONHOOD: 
THE GIFT OF THE ALZHEIMER CHRISTIAN AS A WAY 
OF RE-CONNECTING OURSELVES TO GOD, THROUGH WHICH 
THE RECLAIMING OF THE GIFTS OF THE CHURCH CAN ASSIST US. 



BY 



BLAIR ALAN HAGGART 



Bachelor of Arts, University of Victoria, 1987 
Master of Divinity, College of Emmanuel and St. Chad, 1991 



Submitted in partial fulfillment of the 
requirements for the degree of 
DOCTOR OF MINISTRY 
May, 2008 



WMfcLBMWTYSCHOOlUHWflt 

98 BfiATTLE STREET 

CAMBRIDGE, MA 02108 



© Copyright by 

BLAIR ALAN HAGGART 

2008 



Approved By 



Supervisor 



The Rev. Dr. Richard D. McCall, Ph.D. 



Associate Professor of Liturgy and Church Music 
Provost of St. John's Chapel 
Episcopal Divinity School 



Reader 



£k 



The Rev 



;vyt)r. : 



•ifrnL-. 



Sheryl A. Kujawa-Holbrook 
Academic Dean 
Episcopal Divinity School 



This work is offered in faith to support the work of the church 
and in grateful acknowledgment of those who have supported 
me in this journey. 



To my wife Jerryann who stands beside me and has offered me 
her valued insight and affirmation. To Joan and Ken Mayzes 
who together walked the difficult path of Alzheimer's disease 
with great love and faithfulness toward each other, and who have 
provided me the inspiration for this research. To Janice Halstead 
for her profound theological insights, editorial gifts, and 
unquenchable enthusiasm. To Diana Slater for her kind assistance 
and expertise in the statistical research which has shown to be a 
valuable portion of this thesis project. To Richard (Kip) Slater, 
Brian McCormack and his wife Anita Brideau, The Rev. David 
Peterson, the Rev. Herb Bibbs, and Kerrie Pulford, (St. Peter's 
Anglican Church Administrative Assistant) who have offered 
their kind assistance and support. To the members of St. Peter's, 
Campbell River and St. Philip's, Cedar, The Venerable Gordon 
Payne, The. Rt. Rev. Barry Jenks and The Rt. Rev. James Cowan 
for their loving encouragement. To The Rev.Dr. Richard McCall 
from the Episcopal Divinity School for his kind supervision. 



IV 



TABLE OF CONTENTS 

Introduction 

a. A personal journey with a person who as Alzheimer's disease 

b. The Parameters of Being Fully Human 

c. A Theology of Persons 

d. An Exploration of the Human Soul 



II. Etiology of Disease 

a. An overview of Alzheimer's disease 

b. The Development and Stages 

c. An Understanding of Dementia 

d. Theological Reflection on Diagnostic Process (Who decides who is diagnosed). 



m. The Subtly of Ageism 

a. Biblical Perspectives 

b. Power Dynamics of Ageism 

c. Social Implications 

d. Ageism at the Congregational Level 

e. Case Studies 

IV. Development of Model for Doing Pastoral Care 

a. Survey Questionnaire Results and Observations 

b. Reflections 

c. Reclaiming the Gifts of the Christian Community 

d. The Power of Sacramental Ministry 

e. The Creation of a Eucharistic Rite for Persons with Alzheimer's disease. 

f. Transformational Ministry of the Local Congregation 



V. Conclusion 

a. What can Alzheimer's Persons Teach Us? 

b. What can we learn about ourselves? 

c. Towards a Theology of Persons 

Endnotes 
Bibliography 

Appendices: 

Survey Questionnaire 

Clergy Responses to the Survey 

Raw Data: Survey Responses 



Chapter One 

My journey of ministering to persons with Alzheimer's disease began several years 
ago in my former parish of St. Philip's Anglican Church on Vancouver Island. There I 
had the privilege of making a wonderful connection with John, a gentleman in his early 
70's. John was first diagnosed with Alzheimer's disease in the early months of the year 
2000. When I first met him he was able to make many normal transitions in life such as 
looking after his personal needs and remembering specific incidents regarding his family. 
As his disease progressed, however, some of the ordinary moments in his life became 
more difficult. He was starting to wander around the house for no apparent reason. His 
moods also began to change, and the once quiet and reserved gentleman began to have 
frequent outbursts of anger. John now needed to have someone with him whenever he 
left the house. Basic errands were 'basic' no longer. As things began to worsen, John's 
wife found she had to keep a close eye on him so that he wouldn't unknowingly cause 
harm to himself, like leaving an element on in the kitchen stove, for example. 

Naturally, John's wife became more and more concerned about his condition and, after 
three years of providing the best possible love and care for her husband, she became 
resigned to the fact that he needed more care than she could handle. He was eventually 
put into temporary care in hospital for observation and diagnoses. Six months later he was 
placed in a local extended care facility in the city of Nanaimo on Vancouver Island where 
he would be able to live out the rest of his life in relative comfort, receiving the care that 
he required. 



It was at this point that my ministry to John took a rather unique turn. I began making 
bi-weekly visits to him in his new home, and on these occasions I would, after a brief 
conversation, offer either a concluding prayer or, on occasion, I would give him Holy 
Communion. As both John and his wife were active members, I knew that John would 
have some degree of familiarity with the Eucharistic service so, when I offered him 
communion, I decided to use the older, more familiar rite from the Canadian Anglican 
Book of Common Prayer. In this particular order of service there is the phrase the priest 
says at the point of giving the consecrated bread, "the body of our Lord and Saviour Jesus 
Christ which is given for thee, preserve thy body and soul unto everlasting life, take and 
eat this in remembrance that Christ died for thee, and feed on him in thy heart, by faith, 
with thanksgiving". 1 In the same way, when the communion wine is given, the priest 
says the following words, "the blood of our Lord and Saviour Jesus Christ which is given 
and shed for thee, preserve thy body and soul unto everlasting life, drink this in 
remembrance that Christ blood was shed for thee, and be thankful". " 

On nearly every occasion, whether John had received the sacramental ministry of the 
Eucharist, or prayer for that matter, I noticed a change. These familiar words seemed to 
bring him, albeit temporarily, out of his Alzheimer's state and back into the real world. 
Something in John's condition changed. It could only be described as some form of an 
"awakening". This awakening resulted in a noticeable "glow" on his face and, in the case 
of receiving the Eucharist, an audible response of a series of repetitions of the word 
"amen". Reflecting on those experiences with John, I have come to recognize that similar 
behaviours are exhibited whenever various forms of ministry are shared with persons with 



Alzheimer's disease and dementia. When I lead worship in an extended care home using 
gifts such as prayer, the Eucharist, forms of music and human touch - a shift happens 
inside them. Those seemingly 'lost' appear to be more aware of their surroundings, 
graced with moments of awakening through long held faith, when otherwise they would 
not be responding. 

I must admit that this concept of an "awakening" came to me from another source - 
the prominent neurologist, Dr. Oliver Sacks and the findings in his treatment of patients 
who suffered from Parkinson's disease and encephalitis lethargica in the early 1960's. He 
believed that his patients were very much alive inside even though they showed obvious 
signs of being in a comatose-like state. Some of his patients hadn't moved in decades, 
particularly those who contracted the sleeping sickness disorder which was rampant in 
the early 1930's. I have come to admire the compassionate work of Dr. Sacks. He 
observed that by supplementing collaborate drug treatment alongside forms of human 
contact, love, touch, and music he was able to bring his patients out of their sleep disorder 
into brief periods of an awakening. He noticed a type of change and a transition within his 
patients. He believed that his patients were still fully human, in spite of their physical 
impairments - humans who could still be reached by the playing of a particular piece of 
music or the touch of a human hand. 

I have found the work of Dr. Sacks to be invaluable to my ministry to people with 
Alzheimer's Disease dementia, like my friend John. It seems that there is maintained a 
very obvious "inner power" that is associated with the many and varied gifts of the 



church that have a way of connecting with God on a very deep level. Though stricken, 
these people remain hosts to the Divine. Many of my colleagues have shared similar 
personal experiences and observations when doing ministry in hospital and nursing home 
settings. They have noticed where the power of the Eucharist, prayer, human touch, music 
and the Word, has initiated some form of transformation whenever residents are receiving 
these gifts. One colleague in particular remarked that when he went to give the Eucharist 
to someone who was in a medically diagnosed coma - at the moment the sacrament was 
brought to her mouth, she immediately awoke. His own experience was one of complete 
awe at what he saw happening. 

There have been other common observations made with respect to the benefits of 
active ministry in nursing homes in regards to persons with dementia and clinically 
diagnosed levels of Alzheimer's disease. Over the years, many colleagues have had 
similar experiences with their parishioners as I did with John whenever The Lord's Prayer 
is said, or whenever a familiar hymn is sung during worship. Ordinarily, those who would 
not make any verbal response in normal conversation, would suddenly be able to 
complete the Lord's Prayer without incident, and have an easy recall of the words of 
some well known hymns. For one brief moment, it is as if the gifts of the church, and the 
power behind them, connect with people in such a way that they are once again residing 
in a familiar world. 

These observations open a window of opportunity through which we can explore 
the deeper question of what it means to be alive and fully human within the Christian 



context, especially with regards to persons who happen to have entered the world of 
Alzheimer's Disease and other forms of dementia. It allows us to begin a journey in the 
discovery of a Theology of Personhood. It is a very difficult, if not daunting, task to try 
and create a 'criteria' for an authentic understanding of what it means to be human. I 
believe to do so would lead to a model of exclusion that would run the risk of suggesting 
an essence of humanness based on peoples' development and abilities. Dr. Stanley 
Hauerwas, a leader in the field of Christian ethics, suggests that any form of categorizing 
people on the basis of their abilities can easily lead into treatment which is inhumane. 
One can not make a reduction of people into a criteria. To be human in this sense "is to 
be open to the call of what we are not, and there is therefore no chance that our humanity 
will be enhanced by excluding from our ranks those who we do not understand as 'we'." 

iii 

But how do we even begin to ask, "What does it really mean to be human"? This 
question is one which has haunted humanity for centuries. One wonders, with the ever 
increasing technological dependency of modern society, if classic Christian theology and 
its rich traditions even has a voice in this debate. I believe that it does. We know, for 
example, that the very question of our identity as human beings within the Christian 
context began being asked in the Biblical stories of Genesis. Here, in the very beginning 
of our traditions, we discover the unfolding of God's plan for humanity as a people who 
have been created in God's image and offered access to the rich diversity of creation 
throughout all of the stages of life. Ours is a theology that reminds us of who we are in 
our connectedness with God. Many have given a great deal of thought and reflection to 



how God, in His created order, connects with those He loves. We may, for example, think 
of the way in which God's word come to life in Jesus himself. His whole earthly journey, 
it seems, was to connect people to the greater reality of what God was doing. How God 
was able to visit the earth in human form, for example, in order to become intensely close 
to people's situations and experiences. In the Christian context, we are human specifically 
because God wants to connect with us. 

If we were to look closely at some of the specifics of Jesus' own ministry it becomes 
particularly obvious that this sense of connectedness was at the centre of the lives he tried 
to touch. His focal point, was to connect with the brokenness of the world, where peoples 
lives had become shattered through all manner of sickness and disease of body, mind and 
spirit. The Gospels suggest that Christ spent at least two thirds of his ministry healing, 
curing disease, and meeting with those on the fringe of society. The quality of being 
human was denied to no one. Every person Jesus connected with was treated as unique 
and valued as if, at the moment, they were of sole importance. It was in their lives that he 
wanted God's love to intervene. He wanted to give them the assurance that their search 
for meaning was securely in the hands of God. Marianne Hicks, in her book, " Our Search 
for Identity ", offers this answer for our question "What does it mean to be human?" in 
relation to Christ's method of ministry, "our connectedness with God is embraced with 
the very virtues of incarnation, wholeness, and uniqueness." 1V 

Hick's work, I believe, gives us tremendous insight into what it means to be human, as 
does the work and words of several classic writers of the church's early history. One may 



easily spend several years on this endeavour, but for our case it may be helpful to 
consider, briefly, the thoughts of St. Augustine of Hippo, a man who wrestled personally 
with this question. History reminds us that as a lead up to the time of St. Augustine, the 
church had many prominent figures who tried to gain a deeper understanding of the 
human soul or "psyche" in terms of its relationship with God. Tertullian, in the latter part 
of the first century, to give one example, wrestled with the idea that the soul was 
somehow connected with each newborn person and it remained with them throughout 
their entire life. In his view, however, the soul itself was produced by the child's parents. 
In the latter part of the second century, Origen suggested that the soul was somehow 'pre- 
existent' before it came into the life of an individual. When St. Augustine eventually 
began his search for the meaning of what it was to be human, he did so under the 
influence of several schools of thought that were in play at the time. His own reflections 
led him to many years of asceticism in order to ponder more deeply these suppositions. 
During this period of reflection, Augustine found himself in a tremendous inner search for 
meaning in life in the midst of everything that he had experienced thus far. His primary 
search had to do with a sense of separation that he felt between the soul and God. It 
seemed could the two could not be unified as one because God was not in control of the 
things that human beings were choosing to do. 

It was obvious that St. Augustine was very unsettled by some of his own reflections 
and conclusions. He was not happy with the path his life was taking. Furthermore, as his 
own personal story unfolded he became increasingly aware of God's presence in his own 
journey and his own search for meaning. He realized that, in spite of his own dilemma, 



the question of what it means to be human was really a dialogue between humanity itself 
and God. In one of his essays Augustine describes the difficult path he trod in his search, 
"I panted for honours, for money, for marriage, and you were laughing at me. I found 
bitterness and difficulty in following these desires, and your graciousness was shown in 
the way you would not allow me to find anything sweet that was not you. . . Let my soul 
long to you now that you have freed it from the gripping birdlime of deadness. How 
unhappy it was then! And you pricked it on the quick, so that I might leave everything 
else and turn to you. . . I was unhappy indeed, and you made me really see my 
unhappiness". v 

These reflections illustrate the honest struggle of a man searching for answers to some 
of the deepest questions in life. Interestingly, St. Augustine never fully resolved his 
dilemma, but he did come to believe that there can be no separation between humanity 
and God. In many respects the work of St. Augustine is typical of the universal search for 
meaning that has been a part of our dialogue for several millennium. What he does, I 
believe, is give us permission to continue that search, keeping God always at the centre. 
This is precisely where the church is in terms of its search for a deeper understanding 
when members of the faithful succumb to such paramount disorders as Alzheimer's 
disease and other forms of dementia. All we know is that it is a journey where God is at 
the centre. Furthermore, what it also does is to allow us to enter more deeply into a 
dialogue based on the classic teaching of the Christian tradition - that which remind us 
we are under the umbrella of God's grace which validates our humanity throughout our 
entire life's journey, regardless of any imbalance or impairment. 



Other writers have come forward to offer their own understanding and criteria in an 

attempt to shed light on this mystery of what it means to be human. Some come across as 

seeing things very differently from earlier traditions of Christian thought. From a purely 

biological perspective the work of Joseph Fletcher may be viewed as one offering just 

such a different perspective. In the early 1970's, Fletcher designed an entire biomedical 

profile with which to establish grounds for determining what it means to be human. In 

this profile, he calculated that there were some 15 positive and 5 negative proponents that 

made up 'being human'. 

"To be a man we must be capable of self-awareness, self-control, 
have a sense of time, futurity and past, be capable of relating to 
others, show concern for others, be able to communicate, exert 
control over our existence, be curious, be open to changes, have 
proper balance of rationality and feeling, and have a unique identity. 
Negatively, men are not any of the following: anti-artificial, 
essentially parents, sexual, worshippers, or a bundle of rights"™ 

In light of current classical thought one might conclude that Joseph Fletcher's design 
of biomedical profile seems very dated and almost archaic. Certainly if one isn't from the 
scientific community, this conclusion could be somewhat challenging. Before dismissing 
his work altogether, it should be acknowledged that some of his work may serve as a vital 
component in providing physicians with a model on which to build an objective point of 
view whenever making a clinical diagnosis. Any qualified physician might make the 
argument that something has to be labelled in order to ascertain which measure of 
treatment is necessary. It would be impertinent not to consider all of the facts before any 
treatment or therapy should begin. On the other hand, some of Joseph Fletcher's 
conclusions, which are drawn solely from the scientific tradition, make rather strong 



assertions that being human is somehow determined by specific, measurable, factors in 
the human condition. These conclusions may challenge other non-scientific perspectives; 
particularly in regards to Fletcher's findings on what denotes humanness. It would seem 
that the door is left wide open, at least from the scientific perspective, as to what 
limitations impact personhood. 

Let us expand this dialogue by considering the extensive theological reflective work 
done by Dr. Hauerwas in his ministry to persons suffering various forms of mental 
retardation. In his own exploration, Hauerwas suggests that the insight of Joseph Fletcher 
predetermines that these persons are less than human on the grounds that they would fall 
outside of his criteria model. It appears that Fletcher believes that the critical variable is a 
minimal intelligence function provided by the neo-cortex. If something is lacking in this 
area, however, 'being human' becomes questionable. It's obvious that someone who has 
dedicated so much of his life in the area of working with the disabled, would honestly 
wrestle with some of Fletcher's assertions, particularly as they dismiss all other aspects 
of personhood for those living with cognitive disabilities. They have no chance at ever 
being seen as a part of the human family. In Joseph Fletcher's own words, "any 
individual who happens to be below the standard intelligence quotient (I.Q.) of 40 in the 
Stanford-Binet testing is 'questionably a person', and if you happen to score 20 or below 
you are not a person". ^ 

Dr. Hauerwas' reflections of the challenges presented in Joseph Fletcher's work are 
born out of a theological perspective. They invite the faith community to take a critical 



10 



look at how it views humanity in the light of such viewpoints. In so many ways Fletcher's 
scientifically drawn conclusions are a drastic departure from the classical teachings of 
Christendom; the commitment to minister to all people, as affirmed by Christ himself 
when he said, "I have come that they might have life, and have it abundantly'." (St. John 
10:7-10) NRSV. On the other hand, one cannot dismiss the scientific world out of hand. 
It reminds us that truth that is being sought from a variety of perspectives and fields of 
study. Fletcher's work may very well be a search for the understanding of the human 
condition based on the inner workings of the mind as they relate to the placement of being 
"normal" in society. The search via the theological perspective, the one that calls to me, is 
a much broader endeavour; one based on experience with specific reference to those who 
have entered the world of Alzheimer's disease, and how that relates to the totality of 
God's love in a person's life. 

In the case of my experience ministering to my friend John, it would be an interesting 
exercise to see where he might fit in, in terms of Joseph Fletcher's criteria model of the 
biomedical profile. My guess is that he would fit very few, if any, of the required 
categories. His advanced Alzheimer's disease would preclude him from being capable of 
self-awareness, self-control, having a sense of time, having a sense of understanding with 
regards to future or the past, or be capable of relating to others in any 'normal' way. By 
this definition John ceases to be human, bringing to light some of the tensions that are a 
part of the ongoing dialogue between the scientific and the faith communities. Perhaps 
the question here is not so much about determining the essential criteria to declare 
whether or not another is in fact human, but, as Dr. Hauerwas suggests, "being able to 

ll 



preserve and enhance what humanity we have. In other words, the question of the criteria 
of the human should not be raised about others but only about ourselves". V111 

One way of bringing additional light to the subject is to return to the insights of St. 
Augustine. Before the end of his life Augustine concluded that all of life is a measure of 
our humanness. We bring together a compilation of all of our experiences which continue 
to be a part of who we are in all of life's stages. St. Augustine may very well be saying 
"our humanness never leaves us, it is begun, continues and ends with the living God". To 
my mind we have been given an incredible gift in terms of his reflections. I believe he has 
also given the faith community a deeper understanding of how our sense of identity is 
connected with our memory, and our ability to relate to all of life's events and 
experiences. In one of his most celebrated writings, entitled The Trinity , St. Augustine 
asks the question 'what is it that determines our sense of identity in the world?' St. 
Augustine cited the example of persons suffering from forms of amnesia. It was assumed 
that the individual with amnesia was somehow stranded in a present without a past, and 
that such a person has no memory. An undamaged memory supplies us with an endless 
array of how we view ourselves and the world. It is where we can not only remember 
certain aspects of our personhood, but where we can also view ourselves in the same light 
as might an observer. As St. Augustine himself puts it, "this is where I bump up against 
myself, when I call back what I did, and where, and when, and how I felt when I was 
doing it. This mystery of being both the observer and the observed finds in it a trace of 
the way God is 'in God's company in the Trinity". 1X It could be said, then, that being 
unable to remember is a threat to our identity and, by association, our personhood, our 

12 



being human. 

It could also be said, therefore that memory, then, also plays a very important part in 
how we make the connection between ourselves and God. Such memory, according to the 
work of noted theologian Dr. David Hogue in his book entitled Remembering the Future, 
Imagining the Past , helps in the retrieval of some of the basic qualities in life which 
everyone should enjoy. According to Hogue, "this is where we are able to reconnect with 
those episodes or events that are part of our stories and make sense of who we are, where 
we have come from and perhaps just as important, where we are headed". x Thus, memory 
and identity may be seen as going hand in hand. 

Yet, for our own purposes and reflection, St. Augustine also allows us to see where 
this connection between memory and identity becomes such a vital component in our 
ministry with those suffering debilitating forms of memory loss such as Alzheimer's 
disease. For them, their very identity, "who they are" and the catalogue of all of life's 
episodes and experiences are at risk. Their memories, at best, are a configuration of 
jumbled thoughts and images. It is at this very point where the church can once again 
offer its gifts by coming alongside the individual and, making a "holy intersection" of 
ministry through communal memory; allowing that person a deeper connection with God. 
I believe this is what may have been happening to John during the course of my pastoral 
ministry to him and when the gifts of the church were offered to him. They were building 
a bridge to all of those things that were important to his inner being, reminding him and 
us that he was still a part of the Christian community, and of God's plan of salvation. To 



13 



my mind this was, in essence, was his "awakening". 

John's "awakening" while receiving the sacrament became, for me, a call to deepen 
the search for ways in which pastoral ministry might provide a model that would allow 
persons with Alzheimer's disease, and other forms of dementia to experience a deeper 
sense of God's presence in their lives. Are there specific forms of ministry and liturgical 
practices, for example, that are more helpful in making connections with persons with 
brain impairment and dysfunction? Are there specific hymns and scripture readings that 
are more helpful when conducting a service? As a practitioner in ordained ministry, I 
believe these questions are critical, not only to providing an appropriate liturgical 
framework for this particular model of pastoral care, but as a reminder of our mandate 
as Christians to love one another, following Jesus' example. 

In many respects this exploration is a direct result of some of the realities currently 
facing North American society. Many of the "baby-boomer" generation are now reaching 
retirement age and meeting some of the situations associated with "growing old". We can 
safely assume that there will be more cases of persons suffering from Alzheimer's disease 
and other forms of dementia. We can further assume that our nursing homes will be 
occupied with more cases of people searching for meaning and identity in their world of 
'jumbled memories and experiences'. Yet this searching doesn't have to be one of 
pessimism as people enter into the world of this disorder. Instead it can be one of hope 
as we embrace the humanity that has been with us all along and remains with us, in spite 
of this disorder. Furthermore, it can be a journey full of possibility for all of us as we 



14 



assist our brothers and sisters through the rediscovery and reclamation of the power of 
the gifts of our beloved church, and a reconnection with God to gain a deeper 
understanding of our selves and what it means to be human. Therefore, let the journey 
begin. 



15 



Chapter Two 

As we probe deeper into our understanding of the nature of personhood regarding 
individuals with Alzheimer's disease, it would be wise of us to take a brief clinical 
overview of the characteristics and progress points of Alzheimer's disease and age related 
dementia. Any reflection of this nature must begin with some basic assumptions around 
memory and forgetfulness and what is considered "normal" in the aging brain. All of us, 
at one time or another, have experienced a certain level of forgetfulness or even the 
occasional, brief memory lapse. We have all misplaced, for example, the car keys, or we 
have forgotten to pick something up when we were at the grocery store. When this 
happens, we can justifiably trivialize the event confident that this is merely a temporary 
misjudgment on our part and can carry on with the rest of our daily routines. These minor 
episodes have no significant impact on our lives as, generally speaking, our entire life - 
span includes these types from time to time. The medical profession refers to this 
condition as "benign forgetfulness" and, although a majority of the population 
experiences it to some degree, the causes are unknown. We all understand this facet of 
everyday life as being "normal". Studies also indicate that as people get older there is 
often a "natural" forgetfulness in some individuals, but even then, as the prominent 
neurologist Dr. Daniel Kuhn reminds us, "the common forgetfulness associated with 
aging may be more typical or "normal" in that the majority of older people experience 
this to a degree". M 

We can all think of persons who are aging who show little, if any, difficulty in areas 



16 



regarding memory and forgetfulness. We marvel, for example, at people who in the later 
stages of life, still have very acute, sharp memories and who appear to have no difficulty 
whatsoever recalling both present and distant events. Up until a few years ago, the 
Hollywood personality, George Burns, amazed his fans with his ability to carry on his 
work as an entertainer with relative ease. At the age of 100 years his remarkable memory 
remained intact. Well known political figure, Strom Thurmond, had the ability to serve in 
office as a US Senator representing the state of South Carolina even as he became a 
centenarian. In fact, in 1998, he received a special "Spirit of Hope" award for the 
longstanding service to his country. To this day his record stands as the longest serving 
and oldest Senator in US history, reaching 48 years of service at the age 100. 
Interestingly, we tend to place huge parameters around what is expected of people who 
enter the latter stages of their life. Increased health concerns, impaired vision, and loss of 
hearing are just some of our expectations. One wonders, when we hear examples of these 
Hollywood personalities and political office holders, if our expectations, regarding the 
aged, should be reversed. 

But for our concern in this brief overview of dementia and Alzheimer's disease, we do 
need to consider the percentage of the population who ultimately experience gross 
impairment of memory and cognitive function due to the overall deterioration in the 
human brain. The important question we need to ask is "how does Alzheimer's disease 
change the normal human brain?" First we need to realize that, unlike normal "benign 
episodes" of forgetting, routinely forgetting items, conversations, and time and place, as 
well as experiencing impaired thinking abilities is not normal. Instead, such impairments 

17 



may be the signs of dementia. Most health practitioners consider the word "dementia" to 
be a rather generic term, covering a host of symptoms related to brain failure. Problems 
with concentration, the inability to handle some of the previously simple day to day 
routines in life, to managing personal finances, following directions, or even staying on 
track in a simple conversation may all be signs of clinical dementia. Furthermore, the 
roots of dementia may be varied and as the medical profession has discovered, 
Alzheimer's disease may be one of the leading causes of this. 

It is true that we take a great deal about how we live our lives for granted. We give 
little thought, for example, to our ability to see, move about, breathe, feel, touch or form 
thought. Only until we are faced with some type of trauma do we look at these attributes 
more acutely. Our cerebral cortex (human brain) plays a key role in how we use these 
functions, and determines the parameters which allow us to lead normal, healthy lives. 
Essentially the human brain is, according to neurologists, a "high powered 
communications network. The average human brain has an estimated one hundred billion 
nerve cells, or neurons, that normally work in harmony through a series of intricate 
chemical signals to store, process, and retrieve information. There are an estimated 
15,000 potential connections, or synapses, for each of these one hundred billion cells". w 
With this in mind, we can easily conclude that normal brain function is acutely at risk if 
certain pathologies such as Alzheimer's disease and other forms of dementia disrupt this 
synaptic cell-to-cell communication. When this disruption occurs, we can almost always 
expect it to be accompanied by some form of life altering event or activity, or some 
significant changes in behavior, which will remove one from the normal realm of 

18 



function. 

We may further wish to expand our original question by asking "Where did these 
initial questions and observations regarding age-related cognitive diminishment get 
raised?" It has believed that Alzheimer's disease has been around for centuries. 
Observations into peoples' behavior, particularly with reference to the acute changes 
noticed when the aged begin to show signs of cognitive decline, have been noted since the 
time of Plato. Nearly 2000 years ago, the philosopher himself remarked that someone 
who was "under the influence of old age", could not himself be responsible for his 
actions, and therefore should not suffer the consequences for any crimes that may have 
been committed. More recently, doctors began to offer medical explanations for abnormal 
behaviors they were seeing in their aging patients. Nearly 100 years ago a German Doctor 
by the name of Alois Alzheimer (after whom the disease was named) discovered, while 
performing a post mortem of one of his patients, several abnormalities within her brain. 
Her name was Auguste D.. In the latter part of the 19 th century, Dr. Alzheimer began 
treating this woman who had been placed in an insane asylum in Frankfurt, Germany 
after family members began to notice increasingly bizarre behavior over a number of 
years. Early reports were that she became grossly confused in regards to her 
surroundings. She also had difficulty remembering where certain rooms of the house were 
located, and had forgotten, most of the names of simple household items. 

By the time she was institutionalized, her deterioration had become severe. According 
to earlier writings of Dr. Alzheimer himself,. "On several occasions, during routine 



19 



hospital rounds, Auguste D. sent the doctor away with a string of curses, telling everyone 
in attendance that he was making sexual advances toward her. . . finally she became 
bedridden, forced by contractures to lie on her side like an infant, her legs drawn up and 
her arms curled across her chest". xni In addition, much like the situation of my 
parishioner, "John", described in the initial chapter of this thesis, Auguste D. was 
showing the signs of displacement or agnosia (from the Greek text meaning "without 
knowledge") which is commonly associated with this disorder. Nothing within her world 
was recognizable. "The look and feel of certain objects no longer triggered any 
connection of what the object was, and what it is used for. Even though vision and touch 
remain relatively intact with the brain; what appeared to have been damaged is the ability 
to put these sensory inputs together into a concept of a recognizable object". ^She had, 
for example, "a curious way of talking and would mix up words of similar or related 
meaning- she would say 'milk jug' instead of cup". ^Sadly, at the age of 55, Auguste D. 
succumbed to the disease which was later to be described and named through the careful 
and critical diagnostic work of her physician, Dr. Alzheimer himself. 

Dr. Alzheimer thus felt it necessary to perform a post-mortem and brain analysis in 
order to gather insight with which to determine the basis for Ausguste D.'s plight, and to 
also make comparative notes regarding healthy brains during other post-mortems. If one 
was able to view a healthy brain alongside Auguste D.'s brain there should be measurable 
differences. A healthy brain allows a person to function normally in all of the aspects of 
day to day living, thus experiencing a variety of emotions and memories. Four small 
clusters of nerve cells within the cerebral cortex play a vital function in imagination and 

20 



memory. Neurologists are aware that the hippocampus is critical to the formation and 
consolidation of long term memory. The thalamus helps with simple day to day 
recognition of episodes and moments and is seen as an important relay station in the 
brain from the sensory organs to the cortex. Immediately below the thalamus is the cell 
structure named the hypothalamus, which plays a critical role in a person's ability to 
exhibit "normal" emotion. Finally, is that component of the inner brain structure known 
as the amygdala which governs emotions, stimulating our sense of fear, for example, 
whenever danger is present. 

Individual's who suffer from Alzheimer's Disease have noted cerebral disturbances 
not found in healthy brains. 'Senile plaques and 'neurofibrillary tangles ' invade the 
small clusters of nerve cells in the Alzheimer's brain, resulting in interference with proper 
neuro-transmissions. When Dr. Alzheimer did his initial research on individuals with the 
disease, in particular the post mortem autopsy done on his patient Auguste D., he came to 
the conclusion that viscous looking amyloid plaques were evident, producing obvious 
neurological side-effects during the person's latter years. When he did detailed 
microscopic work, he noted atypical growths of what looked like "splattered globs of 
paint" across the cortex of the brain. "These plaques were so prominent that they could 
be recognised even on a cut section of the brain that had not been stained, as a large 
number of dense, irregularly edged black spots - very foreign looking, like microscopic 
craters in a biological battlefield. "™ These microscopic plaques became not only Dr. 
Alzheimer's chief discovery, but, a century later, they remain a prominent diagnostic tool 
in helping to diagnose the disorder in an individual. His findings then indicate that a 

21 



person who has this disorder becomes severely restricted in terms of normal brain 
function; which is needed to carry out every day tasks allowing them to engage in the 
world around them. Alzheimer's disease, according to today's American Health 
Assistance Foundation, "is defined as a progressive, irreversible brain disorder with no 
known cause or cure. It attacks and slowly steals the minds of its victims. Symptoms of 
the disease include memory loss, confusion, impaired judgement, personality changes, 
disorientation, and loss of language skills. Always, fatal, Alzheimer's disease is the most 
common form of irreversible dementia". XV11 

Since the initial work of Dr. Alzheimer, our world has seen many advances in our 
coming towards a deeper understanding of this disease. Currently, the medical profession 
is looking at many diagnostic tools that no longer rely on the post mortem procedure so 
that an accurate picture of the brain can be viewed, and steps taken, to help the person 
while they are still alive. Recently developed diagnostic techniques, such as the Magnetic 
Resonance Imaging (MRI), and Positive Emission Topography (PET) Scanning, have 
allowed physicians to make images of the brain so that they may see where the disease is 
progressing. Ultimately, they are aiming to perfect a method of detecting Alzheimer's in 
its earlier stages. 

Perhaps one of the major steps that has been made in the diagnostic evaluation of 
Alzheimer's disease is the recognition of the importance of gathering and comparing 
experiential information regarding the disease, from the patients themselves. Who better 
to offer insight than those who are experiencing the effects of Alzheimer's disease in their 



22 



own lives? On many occasions in my pastoral practice I have had people share that they 
know something is going on inside them that they have no control over. They are aware 
that there are times when they have full recognition of someone, and they are also aware 
that they have episodes where people that they once knew, now appear as strangers. With 
this in mind, it becomes apparent that one of the key aspects in making an accurate 
diagnoses is having an accurate historical picture of the person and making an assessment 
on the basis of the changes that are being noticed. In addition, the observations of spouses 
and other family members and friends can be crucial to help formulate the best medical 
opinion and diagnoses. 

An additional important aspect to our understanding of Alzheimer's disease, 
particularly with regards to insights that may assist caregivers and persons who minister 
to them, are the progressive stages often found with the disease. Health experts, have 
documented common patterns which serve as useful reference points for how 
Alzheimer's disease might unfold in a person. The identification of these transition points 
now allow for more long range planning for the care of persons with Alzheimer's disease. 
Normally, within the average course of the disease, a person with Alzheimer's would 
experience seven stages of diminishment. It is also widely understood that a person 
affected with this disease does not necessarily progress from one stage to the next. There 
may be instances where they are exhibiting several characteristics of each phase, or they 
may 'by-pass' one phase and move into the next. 

At the New York University School of Medicine's Silberstein's Aging and Dementia 



23 



Research Center, Dr. Barry Reisberg has developed several useful frames of reference for 
helping in the diagnostic process for Alzheimer's disease, as well as providing a better 
understanding of how the disease unfolds. According to his research, the initial stage of 
the disease shows very little impairment and there is little evidence during a medical 
interview of any noticeable loss of memory. As the individual enters the second phase the 
loss of certain memory patterns are slightly more noticeable, but these are still rare and 
transient. They may be seen in a similar light to the normative "benign forgetfulness" that 
nearly every person goes through. During the third phase, family members and close 
friends of the individual begin to notice that something is wrong. Here, word or name 
associations become problematic. In some cases during this phase, the actual detection of 
Alzheimer's disease can be ascertained. 

By the time the individual reaches the fourth phase, according to Dr. Reisberg' s frame 
of reference, there is a noticeable difference in how cognitive connections are being made 
and normal tasks such as arranging a meal or planning an event become increasingly 
difficult. The fifth stage offers even more impairment and loss and now there is strong 
evidence that the person is now loosing their perspective of time and place. Dates and 
names are extremely difficult to remember, for example. During this phase, there is also a 
greater decline in knowledge of their own personal history. Apparently, however, there is 
still some awareness of their own name, but the names of spouses and other people are no 
longer familiar. 

In the sixth stage of progression, most of the day to day needs and personal hygiene 



24 



tasks are carried out by caregivers and family members. What is most noticeable here is a 
rapid change in emotion and temperament. It is not unheard of, during this sixth stage, to 
have frequent outbursts of anger as well as periods of hallucination. There have been 
cases where the individual, because of this advanced stage, starts to fear those who are 
closest to them simply because they don't remember or recognize them. If one is able to 
survive the progression of phases thus far, and reaches the seventh stage, profound losses 
of a spectrum of abilities are evident. There is a loss of bodily functions, loss of the 
ability to walk without assistance, the loss of the ability to sit up on their own, even the 
loss of the ability to speak or smile. They are totally reliant on caregivers and are most 
likely living in some form of institution. 

The following chart may assist in clarifying the patterns of decline experienced by a 
person with Alzheimer's as they progress into the seven stages. As set out in the Aging 
and Dementia Research Center in the New York School of Medicine, the stages of 
Alzheimer's disease are: 



Stage 1 - No Impairment (normal function) 

Stage 2 - Very mild cognitive decline (may be normal age-related 
changes or earliest signs of Alzheimer's disease) 

Stage 3 - Mild cognitive decline 

Stage 4 - Moderate cognitive decline (mild or early-stage of Alzheimer's 
disease) 

Stage 5 - Moderately severe cognitive decline (moderate or mid-stage 
Alzheimer's disease) 

Stage 6 - Severe cognitive decline (moderately severe or mid-stage 



25 



Alzheimer's disease). 
Stage 7 - Very severe cognitive decline (severe or late-stage 

xviii 

(The Aging and Dementia Research Center) 

Upon reflection, there is no doubting that current diagnostic methods and stages, as a 
clinical frame of reference, are invaluable, providing the medical community and 
caregivers with a profound insight into this strange and mysterious world. This brief 
overview (albeit from a lay person's perspective) also suggests that we are still only 
scratching the surface when it comes to understanding parameters of this complicated 
disease. A more thorough investigation into some of its root causes, and a more detailed 
study of degenerative diseases of the central nervous system (which includes Alzheimer's 
and dementia) would be a mammoth undertaking and outside the intended scope of this 
paper. And yet, we are still drawn to ask questions. What do these clinical findings have 
to say about important theological issues around personhood, or concerning the 
church's ministry to persons suffering with this medical disorder?. 

One of the theological concerns being raised at this point has to do with an 
understanding of the "self or perhaps, more appropriately "the loss of self '. If we were 
to reflect back on the insights provided by the recognized seven stages of Alzheimer's 
disease, one of the striking features of this disease is that Alzheimer's persons experience 
"profound losses" in a myriad ways. There are losses in the ability to remember names 
and places, there are losses with regards to personal identity and, certainly within the final 
stages of the disorder, there is a profound sense of loss in a person's ability to meet 

26 



simple, basic day to day personal needs. Perhaps the most graphic example of loss at this 
stage is the loss of control over their own bodily functions, the loss of the ability to walk 
on their own, or the ability to speak or smile. In essence, the loss of self. I am reminded of 
some of my encounters and experiences with my parishioner "John" with whom my 
initial journey into this world of the Alzheimer's afflicted began. (For that matter, some 
of the observations that Dr. Alzheimer used when he treated Auguste D. also apply.) As I 
reflect back on this, I am made aware how both individuals began to loose many powers 
and faculties. As their disease progressed, both John and Auguste D., began to experience 
a "slipping away" of the familiar. Neither of them, for example, were able to remember 
who they were. What became more and more evident, with the clinical onset of agnosia, 
was a marked decline in the number of "worlds" they were used to occupying. They 
became strangers living in a strange world. As they progressed through the various stages, 
more losses occurred; such as language, judgement, foresight and the ability to plan and 
hope for the future. Eventually, and this was certainly my observation of "John", there 
was a complete loss of self-awareness. 

These tragic losses are also profound opportunities for further exploration in the 
theological realm of personhood. What, for example, constitutes the loss of "self '? Does 
the fact that one may have lost self - awareness, really mean that they have, in essence, 
lost "self? My own observations lead me to believe that, in some profound way, the 
sense of "self ' - even as it pertains to persons with advanced forms of dementia - still 
exists. Perhaps this deeply buried self was what was rising to the surface during my 
observations of my parishioner "John's" episodes of awakening during the Eucharist. As 

27 



he was receiving communion and hearing the words "The Body and Blood of our Lord 
and Savior Jesus Christ preserve your body and soul unto everlasting life", there was his 
repeated response of "Amen". For brief periods, while he was receiving the Eucharist, I 
also noticed John moving from a state of being almost catatonic to becoming more alert. 
What was going on? One might suggest that something profound, one might say 'divine', 
within "John" was connecting to a source beyond his limitations. In the midst of his 
advanced Alzheimer's stage it acted to remind him that his sense of "self ' was not "lost". 
Even though "John" may have experienced losses or lapses in "self-awareness", we 
cannot make the conclusion that there was a loss of "self '. 

Where might this path be leading us in our search for a deeper meaning of what it 
means to be human; to occupy "personhood"? Time and time again, our attention is 
caught by the perpetual human struggle to find ways of expressing our 'essence' - 'our 
being' - in all stages of this pilgrimage called life. We find a sense of meaning, or a sense 
of "self ' throughout most of this journey. It is only in the final stages, accompanied by 
loss, that our sense of "self comes into jeopardy. This struggle is powerfully illustrated 
in Act II of William Shakespeare's play 'As You Like It', where the sense of 'self is seen 
as whisping away to nothingness at the end of life's journey. Here, the character Jacques 
takes his listeners through the seven stages of the human journey that comprises life. The 
scene is set where "all the world is a stage", and as the years march along human beings 
are met on this stage with youthfulness, education, love and passion, maturity and service, 
and contentment. Finally, however, as the journey draws to a close, what was once 
youthful exuberance, full of goodness and vigor, is now void of the life it once knew. In 

28 



the end, it appears we are without anything. 



"All the world's a stage, 
And all the men and women are merely players: 
They have their exits and their entrances; 
And one man in his time plays many parts, 
His acts being seven ages. At first the infant, 
Mewling and puking in the nurse's arms. 
And then a whining school-boy, with his satchel 
And shining morning face, creeping like snail 
Unwillingly to school. And then the lover, 
Sighing like furnace, with a woeful ballad 
Made to his mistress' eyebrow. Then a soldier, 
Full of strange oaths and bearded like the pard, 
Jealous in honour, sudden and quick in quarrel, 
Seeking the bubble reputation 
Even in the cannon's mouth. And then the justice, 
In fair round belly with capon lined, 
With eyes severe and beard of formal cut, 
Full of wise saws and modern instances; 
And so he plays his part. The sixth age shifts 
Into the lean and slipper' d pantaloon, 
With spectacles on nose and pouch on side, 
His youthful hose, well saved, a world too wide 
For his shrunk shrank; and his big manly voice, 
Turning again toward childish treble pipes 
And whistles in his sound. Last scene of all, 
That ends this strange eventful history, 
Is second childishness and mere oblivion, 
Sans teeth, sans eyes, sans taste, sans everything". 



(William Shakespeare) 



It would seem that the poignant phrase that is voiced by Shakespeare's character, 
Jacque, is that of sans or without. Is it really true that without our eyes, without the ability 
to have sight, without the ability to have taste, or in the journey of those within the 
Alzheimer world - without the ability to remember or process thoughts normally, that we 



29 



are actually "without self? From a diagnostic point of view, there are a number of 
scientific observations which certainly cause us to be aware of the profound 'losses' 
experienced by the Alzheimer person. Yet it would also seem that there is a more hopeful 
way to approach things. There is little debate in suggesting that diagnoses provide 
structures which enable physicians to, hopefully, move patients from a state of disease to 
a state of health, or to at least to alleviate their suffering in some meaningful way. John 
Swinton, in an article written for the Journal of Religion, Disability and Health, reminds 
us that as important as the diagnostic process might be "they do not (or at least should 
not) comprehensively define the nature of the experience of the diseased person. They 
can tell us some things about dementia, but they cannot tell us other things. One of the 
errors that has been made in seeking to understand people experiencing Alzheimer's 
disease and other forms of dementia is that we have allowed the diagnoses and the 
diagnostic characteristics to determine the way in which we conceptualize and act 
towards the person who receives them". ** 

These comments are extremely helpful. They make room for the theological 
perspective which says our "personhood", and sense of "self ' finds it origins in the 
deliberate actions of our Triune God, who connects with us and responds to us throughout 
this life and beyond. In light of this what gifts can the Christian church offer so that, in 
concert with the medical community, 'recovery of the self for the Alzheimer person 
becomes a universal concern. According to our earlier reflections from the writings of St. 
Augustine of Hippo, the church community must strive to instil hope in the lives of 
people even though they may be on the widest possible fringe, to draw them into a deeper 

30 



experience of the love of God, and to remind them of their sense of "self through that 
love. 

We also see evidence of this type of pastoral support from medical community itself. 
Returning to some of the earlier work done by Dr. Oliver Sacks, whose insight has been 
influential in my own theological enquiry, we are reminded that the sense of self is not 
necessarily lost whenever there is any acute abnormality within the human condition. In 
his own observations as a clinical neurologist, he sites examples of many of his patients 
who have the miraculous ability to retain parts of themselves, musical ability, for 
example, even though they have entered the final stages of Alzheimer's disease. In his 
book Musicophilia , Dr. Sacks tells of one gentleman, whose wife was under his care, 
noted that although his wife had been diagnosed with Alzheimer's disease seven years 
ago - the essential person miraculously remains. . . "she plays the piano several hours 
daily, very well. Her present ambition is to memorize the Schumann A-minor Piano 
Concerto. . . Yet, according to Dr. Sacks, this is a woman who is, in most spheres, grossly 
forgetful and disabled. And what is most striking here is not merely the preservation but 
the apparent heightening of musical powers and sensitivity, as other powers wane. Rather, 
the extremes of musical accomplishment and illness are so plainly evident in her case; a 
visit becomes miraculous as she transcends the disease with music". ^ 

These observations by Dr. Sacks carry within them a sense of hope not unfamiliar to 
the Christian church. Even in the dark depths of dementia, light can shine and miracles 
blossom. It is as if identity has such a deep and profound basis - God rooted, and 



31 



ingrained within the human psyche - that it is never wholly lost. When we consider our 
own ways of connecting with those who have this disease - the sacramental offerings, the 
Biblical story, hymns, and rituals - the Church can do no other but continue to remain 
open to the miracle of the presence of "self ', regardless of the impairment wrought by 
Alzheimer's disease. 



32 



Glossary of Terms Associated with this Chapter 

Agnosia - Loss of the ability to identify everyday objects and their uses. 

Amygdala - A mass of grey matter in the anterior portion of the temporal lobe. 

Amyloid plaques - A protein complex having starch-like characteristics produced and 
deposited in tissues during certain pathological states. 



Cerebral cortex - A thin layer of gray matter made up of neuron dendrites and cell bodies 
that compose the surface of the cerebrum. 

Hippocampus - The hippocampus is a part of the forebrain, located in the medial 

temporal lobe. It is responsible for short term memory, and damaged 
early in Alzheimer's disease. 

Hypothalamus - A portion of the floor lateral wall of the third ventricle of the brain. 

Neurofibrillary tangles - Groups of threadlike fibers found in brain cells damaged by 

Alzheimer's disease. 

Thalamus - Located just above the hypothalamus; its functions are to help produce 

sensations, associate sensations with emotions and plays a part in the arousal 
mechanism. 



33 



Chapter Three 

As we continue in our theological enquiry into a deeper understanding of personhood 
and the Alzheimer's individual, we must acknowledge the restricting influence and 
pervasive practice of ageism. At every stage in our lives we are met by the inevitability of 
our own ageing. As we journey through life, we cannot help but be reminded of the 
affects of ageing as it relates to the relationships we engage in, the physical changes we 
notice within our bodies, and the attitudes we accumulate that help shape our 
surroundings. Generally speaking, we tend to create close relationships with people who 
are the same ages as ourselves and, whether or not we believe it, most of our day to day 
decisions are aged-based, including social judgements. Naturally, there are exceptions to 
this rule, and we do find moments and relationships in which our awareness is raised as a 
result of age diversity. We tend to hear, for example, about Hollywood personalities who 
have married or entered into relationships with people a fraction of their age. John 
Macnicol, in his book, Age Discrimination, An Historical and Contemporary Analysis, 
reminds us of a powerful example of this in the life of the actress Joan Collins. "In 2002, 
the actress marred a man thirty-three years her junior, and it was newsworthy, not merely 
as a tabloid story, but because it broke such unwritten and powerful rules about aged - 
based relationships". xxu 

Society is still attempting to gain a deeper understanding of how we look at life on the 
basis of age. The underlying feeling, however, is that age is still a powerful trigger of 
discrimination in our modern world along with class distinction, race, ability, gender, and 



34 



orientation. Here, people are not only open to powerful, and sometimes overtly violent 
episodes of discrimination, but they often find themselves deprived of some of the most 
common expectations of life, such as equality in the work force, a voice in society, or 
political freedom. Hence, they are seen as a people with little influence or power. Noted 
psychologist A. J. Traxler defines ageism as, "any attitude, action, or institutional 
structure, which subordinates a person or group because of age or any assignment of roles 
in society purely on the basis of age". """This is yet one more burden to be borne by those 
struggling with Alzheimer's disease. 

A.J. Traxler's insights clarify the potential depth and breadth of how people, simply as 

a result of their age, might be treated. We must be mindful that not all situations of 

ageism are blatant. People are often brought to submission through very subtle methods 

which still result in fewer opportunities to experience full and free lives. In this third 

chapter we are led to consider the following questions, "How does ageism and its quiet 

subtleties manifest its way into the life of faith communities, and what are the social 

implications arising as a result of this?" One way of entering into this discussion is to 

look at some of the perspectives regarding the sense of value placed on human life as 

outlined for us in the scriptures. At the very heart of the Christian Gospel, for example, 

we find a very curious message given by Jesus to his disciples which has generated much 

discussion and reflection over the years. In the Gospel according to John, we hear Jesus 

saying the following words: 

"So again Jesus said to them, 'Very truly, I tell you, I am the gate 
for the sheep. All who came before me are thieves and bandits; 
but the sheep did not listen to them. I am the gate. Whoever enters 



35 



by me will be saved, and will come in and go out and find pasture. 
The thief comes only to steal and kill and destroy. I came that they 
might have life, and have it abundantly'. " (St. John 10:7-10) NRSV 



What might Jesus have meant when he said this? Since its inception, it has been our 
common understanding that much of the church's mission; through her teaching, pastoral 
care, and evangelism - has defined the core of the human experience to be the God-given 
mandate to have life, and have it abundantly. This is particularly evident within current 
context in which congregations engage in ministries specifically to explore this question 
so that they might assist and empower people to becoming fully alive persons, living to 
their fullest potential. We see this, for example, in the wide range of outreach programs 
designated for youth on the fringe; ministry to the poor, food banks, drop-in centres, 
support networks for single parents, and the like. The same can be said, of course, for its 
mission towards those others who are on the other end of the age spectrum of society, 
namely those who are elderly and the infirm. One might therefore draw, from this 
Gospel text, the conclusion that fullness of life is something toward which we are 
constantly moving. It is a life process. After all, the community of faith is comprised of 
persons on a journey, en-route to completeness and wholeness through growth, through 
change, through searching and through development. If what our tradition and the Gospel 
tells us is true, life is a continual process of growth, of movement and of development. 
Life, then, can be seen as a constant challenge to accept this reality as expressed by 
Fournier and O'Malley in their book, Age and Grace . "This outlook demands growth and 
change at every stage of our lives right up to and including our death, which, the noted 
psychologist Elizabeth Kubler-Ross calls 'The Final Stage of growth'. To deny the 

36 



possibility - the necessity - of growth even in old age, for ourselves or for others, is to 
give up on life prematurely, to loose our sense of life's direction, and to settle far less 
than the fullness of life of which the Christian Gospel promised". xjav 

One of the great myths, however, as pointed out earlier, is that this mandate to 
'abundant life' for the elderly is being fully attended to in both general society and in 
faith communities. Research and experience tell us otherwise. Instead of affirming the 
ageing process and all of its attributes society, and particularly individuals in positions of 
power end up trying to deny the signs of ageing in us. We live as if life only has meaning 
and value when we are young. If one is fortunate, for example, to be a young, single, 
heterosexual, employed, white-male then, and only then, are they considered as having 
full and significant value as a person. The reverse is seen in terms of the elderly. Rather 
than being perceived as being free and able to experience the wonderment of life, the 
aged fall prey to myriad stereotypes in which they are labelled as being senile, or rigid in 
their beliefs and convictions, and certainly non-adaptable to change. Furthermore, once 
one has lost the attributes of youth and has transitioned to the less attractive 
responsibilities of middle adulthood, eventual maturity holds few expectations other than 
death. We hear this explicitly in one of the most revered poems by John Keats, "Ode on a 
Grecian Urn", in which the youthful figures displayed on the urn are celebrated because 
they will never succumb to the fate of growing old or perishing. Ironically, according to 
one writer on the subject of ageism, "Keats never had to cope with these problems of 
ageing because he died at the ripe old age of 26, having met that one inevitable fear with 
which is linked all too soon". xxv 



37 



"Fair youth, beneath the trees, thou canst not leave 
Thy song, nor ever can those trees be bare; 
Bold lover, never, never can thou kiss,. . . 
She cannot fade, though thou hast not thy bliss, 
For ever will thou love, and she be fair. . . 
When old age shall this generation waste, 
thou shalt remain, in the midst of other woe 
Than ours, a friend to man". XXV1 

(JohnKeets, 1820) 

If our enquiry is to be an honest and serious attempt to understand the oppressive 
forces behind ageism, it is necessary to examine them through a theological 'lens' 
perspective which reinforces the well being of all people. What might one look like? 
Such a perspective requires that we see God as the hater of anything remotely close to 
life-denying and health destroying and, instead, as a lover of life-affirming and health 
promoting change. Donald Chinula, in his ground-breaking work in unpacking the 
profound teaching of Dr. Martin Luther King Jr's pastoral approach, suggests that a 
theological perspective that both embraces and affirms the transforming nature of God is 
vital to the health of any Christian community. Without it, they will die, or worse, they 
will work against the tide of the intent of Jesus' Gospel. His entire precept is based on the 
idea that God loves life. "In so doing, God affirms health, and promotes biophilic and 
salugenic (health-giving) communities. God will not sit impassionately in the face of 
death-dealing status quo. Emotional, psychological, and spiritual death is equally 
displeasing to God. In the face of these diabolic forces, God becomes not changeless but 
a change agent for the good and for health". xxvu 

Historically, however, acceptance of God as "a change agent for good and for health" 

38 



is shown to be a process fraught with tension. Many well-intentioned groups and 
individuals, through their rather bizarre understanding of the nature of God, have 
reinforced negative patterns as they pertain to human value. Some of the results of this 
way of thinking have been outright oppressive. To site one example of this, Donald 
Chinula goes on to describe how certain Biblical narratives have been used to promote 
intolerance and to retain power over individuals who have little or no voice. The Genesis 
story of Noah and his descendants, particularly in regards to his son Ham, is a case in 
point. As told in the story Ham, father of Canaan, commits an indiscretion concerning his 
father's sexuality. Ham sees Noah naked and apparently treats his intoxicated and 
slumbering father as an object of humour. When Noah awakes, he is told about Ham's 
behaviour. Because of this act of disrespect Noah ends up blessing his other two sons 
Japheth and Shem, with lives of prosperity while cursing Ham and his offspring. Further 
on in the Genesis story the influence of this curse extends to the point that "all the 
descendants of Ham are named, and the list includes Canaan, Cush, Put, and Egypt. Thus, 
to some misinterpretations and strange exegetical logic, the Hamite theory ends up 
identifying Ham and his descendants as black people who were biblically cursed to serve 
the white descendants of Shem and Japheth. In so doing, some biblicists have taken this 
passage to its extreme in order to justify the enslavement and oppression of blacks". 50 ™" 

In a similar manner, other biblical passages have been used to indicate divine approval 
of situations that are both oppressive and life debasing. History reveals that during the 
establishment of the North American colonies, it was common to interpret St. Paul's 
instructions to the early Christians supporting the economically profitable slave trade 

39 



while at the same time reminding those in submissive positions that this was the 

fulfilment of the will of the 'master on high'. After all, it was supported by Scripture in 

the letter to the Colossians: 

"Slaves, obey your earthly masters in everything, not only 
while being watched and in order to please them, but 
wholeheartedly, fearing the Lord. Whatever your task, put 
yourselves into it, as done for the Lord and not for your 
masters, since you know that from the Lord you will 
receive the inheritance of your reward; you serve the 
Lord Christ. For the wrongdoer will be paid back for 
whatever wrong has been done, and there is no partiality ". 

(Colossians 3:22-25 NRSV) 
This being the case, it is not hard to see how the same oppressive, albeit subtle, 
components can be found in the 'good works' of youth communities as the attempt to 
meet the perceived needs of the marginalized, including the elderly. Modern and well- 
intentioned theologians have continued to reinforce old theological models which focus 
solely on the negative aspects to the ageing process. They base their ministry models 
approach on early Augustinian understandings wherein he is said to have described old 
age as a manner of an inferior age, lacking in lustre, weak and more subject to disease - 
namely, it leads to death. Professor Fredrica Harris Thompsett in her book entitled 
Courageous Incarnation takes issue with this perspective, saying that "when such 
theological approaches are used - which stereotype aspects in the life cycle - then 
theological ageism is given birth to. When this happens, there is an unexamined 
presupposition that ageing is inevitably marked by a series of losses without moments of 
life or growth". ^ 



40 



At this point it would be helpful to ask ourselves, "What does ageism look like in the 
average parish context? How does it directly affect the elderly, or even those who have 
entered into the world of Alzheimer's disease and dementia?" The theological work of 
Homan and Pratt offers valuable guidance as we attempt to answer these questions. In 
much of their work regarding the practices of Benedictine Spirituality, they remind the 
church that, in order to fully live out the Gospel intention of life for all people, it must be 
intentionally radical in its dismantling of all forces that work against the Gospel directive. 
In their book Radical Hospitality: Benedict's Way of Love , they introduce us to the 
concept known as 'The Other'. Here, they define "The Other", in the Christian context by 
basing it against those who hold positions of authority or defining roles in the life of a 
given parish. In any normal church setting, there are always groups and individuals who 
have a certain amount of political power which often influences how decisions are made 
and directions taken. It may be a specific governing body within a congregation, such as 
elders or wardens. It may even be families who have had a lengthy association with a 
particular church who believe themselves to hold a prominent position. According to 
Homan and Pratt, "The Others are the ones who you have the power to systematically 
marginalize and / or oppress. They are, to borrow from the Visions Group (a 
congregational development organization which teaches anti-racism), the targets of 
oppression, while those who hold privilege and power are non-targets". xxx 

Upon first glance the tone these authors use appears quite harsh. They are not saying, 
however, that there is necessarily any overt intention to dominate one particular group or 
individual, although this may occasionally happen. Rather, Homan and Pratt are 

41 



reminding us that to identify 'The Other', requires only "the recognition that, within the 
social system in which we all function, some groups have been given social, economic 
and political power over other groups".*** 1 Simply put, it is the potential to exercise power 
over one group or another that works against the health and wholeness of a Christian 
community which would otherwise operate in a manner that welcomes, accepts and 
embraces all. The constant struggle in the Christian context is to continue to see "The 
Other" as individuals with their own unique stories and perspectives who have a great 
deal to offer in the life of the community. 

What might the Other look like? Let us look at a specific case study from my own 
ministerial practice. Unlike "John's" situation, where most of my observations were done 
at the care facility in which he was living, "Jane" (not her real name) is still an active 
member of my present parish. She has been the organist in this church for most of her 
life. Jane is now in her early eighties and is beginning to show the normal signs of frailty 
for a person of her age and stature. On several occasions, she has shared with me that she 
feels somewhat frustrated regarding the challenges and transitions that she is now facing. 
She has expressed a tension regarding potentially having to step down from the position, 
while still having a keen desire to play whenever she is able. Music, in addition to the 
social network of the parish family, has been her life. On one occasion I was honored to 
hear her speak candidly about how passionately she feels regarding her music. She shared 
with me that when she plays, she can feel God's pleasure - she feels alive inside. 

After hearing some of her life's story, I can understand why this is so. In her 



42 



earlier years on the Canadian prairies, she worked at a music teacher to young children, 
often teaching out of her home. As her life progressed, her musical gifts took her to the 
performance level, allowing her to not only play in public, but to also get exposure and 
experience necessary to offer her gifts to the church. Later, she would become the lead 
musician and has remained as such so for the past several years. One interesting note in 
Jane's journey is that even though she is in her early eighties now showing a variety of 
the signs that accompany the ageing process, Jane has not lost her gift of music nor her 
passion for playing. In fact, her talents are still being channelled in other ways beyond the 
parish setting. Although the years have admittedly taken their toll on her musical ability, 
she regularly offers her gifts by playing the piano at two of our local care-home facilities. 

Jane's story, I believe, offers opportunity for personal reflection. As I think about her 
situation, I realise that it is a common challenge in most parishes to be faced with the age 
related concerns of individuals who have held honourable positions for several years, if 
not decades. At one level, Jane's situation could easily be seen as an example of some of 
the day to day struggles within any parish particularly in light of most church 
communities resistance to change. A closer observation, however, offers another 
interpretation. Interestingly, throughout this entire process, there has been a litany of 
congregational responses focused on the age of Jane, and her struggle to adapt to changes 
in direction as the parish evolves. Many of the elected parish officials, for example, have 
entered the discussion and have directly stated that "she should step-down " in order to 
allow for new growth to occur". These comments are often followed by further age-based 
assumptions regarding her physiological condition. "Naturally, Jane is showing signs of 

43 



deterioration... she is more confused. She is, after all in her late 70 's... It seems as if she 
may even be starting to have dementia.. . ". Curiously, as these statements have been put 
forward, there has been little evidence from the family that she has any diagnostic signs 
of any disorder. 

This scenario reminds us of the important work of Homan and Pratt introduced earlier 
in our discussion. A power group, in the form of parish officials, is at work here. They are 
operating within the social system of the parish to make change at the expense of 
someone. In other words, they are practising discrimination regarding Jane's value to the 
parish based on her age. The stereotypical assumptions that would naturally follow as a 
result of this claim of age related diminishment suggest that Jane has now entered that 
stage in her life where she can only expect to have episodes of confusion and possible 
memory loss. Because of these assumptions she has been placed in a specific category 
wherein the focal point is a series of losses. It is implied that Jane can no longer function 
in the same manner as she once could, so this should be a deciding factor in having her 
step down. Furthermore, there is the loss of status, because those in positions of power, 
have now placed her identity at risk by suggesting that she no longer do that which she 
has previously always done. 

I believe that Jane's scenario is not unique when placed alongside our discussion 
around ageism. Within any social network, whether it happens to be a faith community 
or otherwise, there is always the potential to push forward ones' own agenda and wield 
power over a group that falls into a specific subcategory based on age, orientation, class 



44 



or race. Also at work here is in the use of language statements that place people into 
categories, further putting them at risk for additional oppression and discrimination. 
Jane's case study brings us closer to a deeper understanding of how 'language - 
statements', particularly when focused on our identity can, in fact, shape our sense of our 
own reality. This experience mirrors the powerful reflections of Paulo Freire who, in his 
treatise on Pedagogy of the Oppressed , argues very strongly regarding the power that 
language has. From his own experience of working with Latin American communities, 
Freire describes how those in power continually retain the upper hand by making 
'statements of identity' towards those perceived as powerless. The mass population in 
Cape Verde, South America, using one of his examples, has a majority of people living in 
situations of abject poverty, this was seen as the normal way of life. This is how it is. 
"The poor, we always have with us "; this scriptural passage from the Gospel of John is 
widely used in situations such as these and, as such, is widely taken out of context. From 
the perspective of the powerful statement 'they are always with us' has to mean that 
poverty is a life long condition immune from any change that they might consider 
initiating. Solutions, in the eyes of the solvent, are impossible; any attempt to prove 
otherwise is not only futile, it refutes scripture. 

The same argument can be made about others who are made powerless in Christian 
communities, where 'statements of identity' are used as a precursor to the determination 
that this is how it is, so therefore nothing needs to be done to change or alter the situation. 
Older persons, like Jane are under the operative norm which says they must inhabit the 
category of having less to offer, now that they are in their "dotage". They must also 

45 



accept that because they may be experiencing age related physical transformations which 
could result in memory and hearing loss, visual impairments and other 'limitations', it is 
predetermined that there will soon be nothing of value left for them to offer. As language 
is such a formative tool to our understanding of self, it is easy to see how a person's sense 
of identity is threatened when such dismissive statements are in use. Our very humanity is 
at risk. Oppressive language, steals our humanity, replacing it with dehumanisation. As 
Freire was to discover in his work with the underprivileged, a key element at work in this 
theft of humanity is the distortion of the expectations of the oppressed. Because of this, 
full personhood is no longer seen as an option. The sad reality is that this has now been 
ingrained in the Latin American culture has become, as he observed, rooted in its history. 
In order to change the situation, there had to be the recognition of a potential alternate 
reality and an intentional movement towards emancipation in order that 'humanity' might 
be regained. He claimed that "the struggle for humanization, for the emancipation of 
labour, for the overcoming of alienation, for the affirmation of men and women as 
persons would be meaningless. This struggle is possible only because dehumanisation, 
although a concrete historical fact, is not a given destiny but the result of an unjust order 
that engenders violence in the oppressors, which in turn dehumanises the oppressed". XX3Q1 

If we are prepared to take Friere's work to heart then we must also be prepared to 
regularly review all of the structures in place within the various communities in which we 
live and operate. In Jane's case study, we are met with one form of ageism. In this light 
we need to offer new perspectives that raise people such as Jane away from statements 
of identity based on age and towards theological perspectives that offer affirmation and 

46 



promise. To move forward in our discussion it is important for us to explore forms of 
ageism which are not so obvious. Insidious ageism, we might say, is a way of inflicting 
oppression from a 'safe distance'. The source of this subtle form of ageism is often 
difficult to detect. To begin with, there are no hate groups in our present society that 
explicitly target the elderly as there are hate groups that target members of religious or 
ethnic groups, for example. Elder abuse is a crime; a threat to body and soul. Subtler 
forms of oppression, while not always seen as criminal acts, can also be life altering. 
When one's influence and authority is taken because of age, an assault of sorts has 
occurred. People can be subject to a plethora of losses, whether it be status, value, or 
employment opportunities all because they have reached their 'golden' years. Jane's 
situation may be a form of this, because her oppression has come via 'language 
statements' that have now shaped her present reality. "Jane is now just too old, and 
because she is this age, she should step down". 

Ageism is not always intentional. Without adequate thought, well meant attitudes and 
actions can, nevertheless, end up being diminishing and oppressive. To explore what this 
might look like, we turn now to our second case study, and offer important reflection on 
"Margaret's" situation. Margaret (not her real name) is a lady who has served as a faithful 
member of our parish Altar Guild. She is in her late seventies. Until recently, Margaret 
enjoyed relatively good health. Several months ago, however, her situation began to 
change. Her husband started noticing patterns of behavior that were 'out of the ordinary'. 
She had started to misplace objects around the home, common household items not easy 
to loose. At one point she complained of not knowing where the frying pan was, and after 

47 



several attempts of asking her husband for assistance, it was discovered that it was within 
arms reach all of the time. Other household items also went missing, such as a baking tray 
that ended up being found in a closet where clothes were normally kept. After time it 
became clear that Margaret was loosing a sense of time and space, as she began to have 
episodes of not knowing the function and purpose of very common items in the home. 
She could, for example recognize that an object was "frying pan" or a "tea-cup" but she 
had no idea what these items were used for. When her husband finally took her to their 
family doctor, it was determined that she was entering the early stages of Alzheimer's 
Disease. 

When I have made regular pastoral visits with Margaret I have been pleasantly 
surprised by her candidness and her willingness to talk about her condition. On several 
occasions she has remarked that it is helpful for her to talk about how her life is, but that 
she also knows that something is going on inside of her that she has no control over. 
When I hear comments like this, I realize what a profound effect her journey into the 
world of Alzheimer's Disease is having on her life and how there must be a deep struggle 
on her part to maintain a sense of belonging in the church. 

Normally the parish's Altar Guild meets weekly, and because this appears to be a very 
close knit community, there is the sense that church is an important part of the lives of 
many people who are around Margaret's age. Recently, however, it has become obvious 
that Margaret is experiencing a greater struggle in terms of her sense of identity and 
belonging within the Altar Guild group. Now that she is facing Alzheimer's Disease, 



48 



she has become more aware of her limitations and has quietly made the decision to 
withdrawing from some of her normal activities in church life. She has become quite 
anxious, for example, about crowds and this seems to have affected her desire to venture 
out in public. On several occasions she has indicated a fear of making mistakes when it 
comes to setting up the altar and sanctuary area for Sunday worship. She is concerned of 
what people might think if they witnessed her forgetting something or making a mistake. 
Even though the parish Altar Guild has a policy in place where the members work in 
"teams" when preparing the sanctuary for worship, this fear has led Margaret to make an 
almost complete withdrawal from any involvement, and in the last couple of months, she 
has only been in church a few times. 

To add to Margaret's struggle there appears to be a further sense that, because of her 
condition, her ability to make decisions on her own is becoming more limited. Although 
she is still in the early stages of Alzheimer's Disease, and she is still able to function 
reasonably well, there is still very little Margaret can do on her own. Her independence 
has waned to simple day to day decision making, whereas any important issues are now 
in the hands of either family members or close friends. The world Margaret once knew, 
with its freedom and choices, is becoming smaller and smaller. As one reflects on her 
new world, and on the earlier comments made by both Homan and Pratt, one wonders if 
Margaret has now been placed among the so-called "Others" in our society. 

Margaret's struggle with her sense of identity, offers additional opportunity for 
reflection on inclusion of The Other" in established faith based communities. As one 



49 



might imagine, many persons within the parish are struggling to come to terms with 
Margaret's new health situation. How, for example, do they treat her now that it has 
become common knowledge that she has been diagnosed with Alzheimer's Disease? 
How is her membership in the Altar Guild now seen in light of her new condition? As 
these questions are put forward, it is interesting to see how some of the Altar Guild 
members are attempting to come to terms with Margaret's place in their midst. As one 
example, at a recent meeting of the Guild, there was a lively discussion around the overall 
health of Guild members, recognizing the fact that most of the ladies were now into their 
mid 70's and early 80's. Margaret's situation was also discussed, even though she herself 
was not present at the meeting. During this time there were some serious concerns 
expressed that Margaret might be experiencing greater difficulty in trying to accomplish 
some of the usual duties of the Altar Guild. Normally their work involves setting up 
various candles and vessels on the Altar, in a specific order. In an attempt to be inclusive, 
and not meaning any offence, one lady made a very interesting motion. She suggested 
that because Margaret could no longer execute certain tasks expected of a Guild member, 
Margaret be declared "an honorary life-time member". It was evident that this would be a 
non-active role. A vote was taken, and Margaret was unanimously "lifted" to this new 
special membership status. As the meeting ended, the comment was made that finally we 
have addressed this situation and we could now move forward knowing that Margaret's 
needs, in light of her new life's situation, have been met. 

At first glance, this whole process appears to be an admirable gesture, recognizing 
someone who has served so faithfully over the years and acknowledging Margaret for all 

50 



her past contributions. Unknowingly, however, they also burdened Margaret with an 
additional sense of loss. As I have mentioned earlier, one of gifts that Margaret brings to 
the life of our parish family is her honesty and her candid attitude regarding her journey 
into the world of a Alzheimer's Disease. There is the sense that this newly bestowed title 
may place her into yet another area of abandonment. How, for example, does she both 
face and adjust to this new designation? Does it imply that because of her condition, 
Margaret is now a member of the parish Altar Guild in title only and will rarely, if ever, 
be asked to be involved in some of the day to day routines of the guild? 

I believe the discussion regarding Margaret's situation, as it evolved that day at our 
parish Altar Guild meeting, is a profound reminder of how challenging it is for 
individuals and communities to make sense of, and appropriately respond to, life-altering 
events. In this particular set of circumstances we are observing a deep struggle to come to 
terms with a physical and cognitive condition for many that is deeply mysterious and 
incredibly difficult to understand. This dilemma is discussed in the work of physicians, 
Dr. William Molloy and Paul Caldwell, who suggest that the world of the Alzheimer 
person is so blurred that its very mystery is equivalent to an unwelcome guest. "Day after 
day the person they once knew changes, often in bizarre ways, until one day only faint 
traces of the former person remain. Their husband or father, their wife or daughter, along 
with close friends, has been replaced by a bewildered stranger". xxxxn In Margaret's 
situation, offering her the title of "honorary life member" may be the Guild's only attempt 
to describe an uncontrollable event happening to someone for whom they have a great 
deal of admiration and affection. It may signify that they are at a loss as to what to do. 

51 



How true it is, as this scenario suggests, that within humanity's own struggle to 
understand complex issues, our initial reaction is to allow our fear of the issue to "remove 
it" for comfort's sake. 

The circumstances of Margaret's situation is also a reminder of how subtle forms of 
ageism, though often unintentional, can further alienate people, excluding them from fully 
participating in life and all its gifts. The key word in this case study is its subtly, for it's 
clear this was not an intentional act to take away Margaret's voice or remove her from the 
community. It is a case of very concerned, faithful members attempting to provide a level 
of care for someone whom they have known for many years and who is now journeying 
through a landscape that is foreign to them. In essence, what is happening is a prime 
example of the ongoing struggle to place our theological perspectives alongside the very 
real need to find creative ways of keeping "The Other", as Margaret has become; in 
community with her peers. Raising Margaret to the isolated position of honorary life-time 
member has brought that creative force to a halt. There is nothing left in this honorary 
role to remind her of her place, as an active member. Again we are reminded of earlier 
reflections of Homan and Pratt regarding the need for all systems, particularly those 
within the Christian community, to explore all ways possible of becoming welcoming 
and inclusive. 

As well as casting a revealing light on the pitfalls of more specific forms of ageism, 
both Jane and Margaret's stories also lead us back to our initial search for a deeper 
understanding of personhood. This examination of the world of ageism reminds us that 



52 



while, regrettably, faith communities have elements within them which have the potential 
to be destructive, there are also positive elements that invite us to journey forward and to 
reconnect with theological frameworks and languages that are live giving. The call here is 
for every community to be authentic, so that, as a body, they manifest the Christian 
message and strive to embrace all people in their journeys - regardless of orientation, 
gender, race, ability or age. By attempting to live in a community of people who are all 
struggling with their sense of identity and belonging, we will be brought into the very 
purposes of God. Both Jane and Margaret challenges us to answer this call. Margaret, 
having now entered the strange and complex world of Alzheimer's disease, and Jane, 
experiencing the stereotypical results that accompany aging which can only lead to 
physiological deterioration and memory loss, have become "Others". Yet, to merely 
define them as "Other", and, even worse, to leave then as "Other" will only serve to 
further alienate them from the very community whose vocation it is to offering life and 
wholeness to all its members. 

Homan and Pratt's views regarding the need to create holistic communities are echoed 
throughout the theological - academic world. Miroslav Volf and Dorothy C. Bass, authors 
of the book Practicing Theology: Beliefs and Practices in Christian Life , offer a paralleled 
insight suggesting that faith communities must integrate their beliefs with their actions. In 
other words, they must 'practice what they preach'. People of faith must not only be 
willing to discern what resources held within the community are the most helpful, but 
they must take the next step in the journey by also discerning whether or not what they 
are doing is in connection with the purposes of God. According to Volf and Bass, "each 

53 



community of Christians in every generation is already engaged, implicitly or explicitly, 
in just such discernment. Inheriting much but also drawn into relationship with God in 
Christ in the present moment, they care for the sick, bury the dead, bring up children, tell 
stories, and make decisions, sometimes pausing in midstream to discern the possible 
intention of the Spirit". xxxiv One would hope that all Christian communities are involved 
in a constant search for truth and meaning. One would also hope that, those within these 
communities strive to live out their lives under the guiding influence of the Gospel stories 
and the ways of Jesus. 

The question here is, how do we help to bring all of the Janes and all of the Margarets 
into communities which are constantly weaving their beliefs and practices together in 
order that they might fulfill the mission of God? Are there ways, in Margaret's case, for 
example, of making her feel more connected and helping her regain her sense of identity 
and purpose, while, a the same time, seeing herself as one who truly belongs? In Jane's 
case we might raise questions about language - statements that affirm her as a person of 
value and worth, instead of stereotypical age related comments which focus on loss and 
limitations. Asking parish communities to judge whether or not they are making honest 
attempts to remain faithful to God's purpose is an unenviable task. It may provoke 
negative reactions. It could lead to criticism. Yet, to encourage this kind of theological 
reflection is also to claim our role as people of the Triune God and to become instruments 
of redemption. Participation in the work of God puts into place opportunities for nurturing 
and for growth. The task may seem like a struggle against a strong current, but it is one 
which has the ability to offer a ripple effect of promise on a universal scale. In the 

54 



following chapters we will explore how this discernment process is 'fleshed out' within 
faith communities. We will also see how the gifts of the church - Eucharist, rituals, 
hymns, the Biblical story - help to mold a model that not only supports the value and 
dignity of all people, but further dismantles the foundations of ageism. 



55 



Chapter Four 

As we continue our journey towards an understanding of personhood as it relates to 
those struggling with Alzheimer's disease and other forms of dementia, we focus now on 
the need to create an effective model providing pastoral care. This journey has been 
walked, in part, alongside colleagues in ministry. Their insights will prove able tools to 
assist with the task at hand. Previously I made mention of some of the special gifts of the 
church - ritual, the Eucharist, the biblical story, hymns and prayer -gifts which have 
allowed me to make deeper spiritual connections with those to whom I minister. The 
story of the effects of receiving communion on my parishioner "John" provides an 
example of this. You will recall that he also showed signs of an awakening when he was 
offered prayer. These insights and observations will contribute to taking our enquiry to a 
new and deeper level. Not only will we be looking at ways in which the specific gifts of 
the church can help minister to persons with Alzheimer's disease, but also how they can 
become the means of regaining personhood - thereby claiming solidarity, and the ability 
to effect change in, the society that previously shunned them. 

One of the ways in which information and insight has been gathered during this 
process has been via the distribution of a survey questionnaire. In the fall of 2006, 72 
questionnaires were sent out to active clergy of the Anglican Diocese of British Columbia 
to ask about their practices and experiences when offering pastoral care in Care Homes. 
The questionnaire contained seven specific areas of enquiry: the present ministerial 
context; the forms of ministry offered, such as hymn sing or Holy Eucharist; the content 



56 



of the worship (choice of hymns and readings); the practice of the clergy themselves (the 
use of vestments and other signs of ministry); the connections with the residents in the 
care homes (How did they respond during the service? What did they offer?); specific 
ministry to persons who have Alzheimer's disease and other forms of dementia; and 
finally, the level of comfort of the clergy themselves in providing effective care. 

Within one month of the questionnaires being distributed, 40% were return completed, 
while one was returned unanswered for reasons unknown. It should be noted that, due to 
an error in numbering, there was no question 27. None of those who responded chose to 
answer question 12. 1 surmise that the reason for this was that the question itself seemed 
irrelevant. Question 12 asked "on what occasion would clergy wear vestments?", while 
question 1 1 asked "when you offer pastoral ministry in Care Home Facilities, do you 
wear vestments?". Many of the answers to the survey questions were detailed, and there 
was the sense that a good number of my colleagues felt that this was an important survey 
to complete and that they were happy to do so. There were even some unsolicited notes, 
included with completed questionnaires, encouragement to me to continue in this work - 
an area of ministry that has very much become my passion. 

Reflecting on the responses to this survey questionnaire, I am drawn to make certain 
observations and conclusions. It appears that familiarity, whether having to do with the 
selection of hymns or scriptural verses, plays a large part in the positive outcome of a 
service. Nearly, 100 % of the responses to questions regarding service content noted that 
with the choice of familiar hymns, whether "Jesus Loves Me" or "Tell Me the Old, Old 



57 



Story" and well-known passages of scripture, such as the 23 rd Psalm, the service and its 
worship tended towards a more natural and rhythmic flow. This suggests that not only are 
emotions triggered when something recognizable is sung or heard, but more people will 
engage in an event when a familiar dynamic is introduced. Those who answered the 
question regarding hymn selection observed that, although there is a preference on the 
part of some clergy to use other resources (different hymns or songs of praise), the choice 
of many residents is to hear hymns that are 'simple', traditional, and ones which have 
been sung over and over again. Here most clergy use as a resource some form of 'Songs 
of the Faith Anthology'. 

Not only is the choice of familiar music and Scripture a point of agreement within the 
clergy, but the survey also indicates using the BCP service as a liturgy, or some 
abbreviated form of it, is still preferable to more modern liturgies. Over 80 % of the 
responding clergy noted how the "old familiar words" found greater welcome in Care 
Home Facilities. One of the reasons for the clergy's use of the "old" Prayer Book is that 
many of the residents grew up with it. Because of this, 50% of those who responded 
believe that residents receive "sacramental comfort" through the recitation of these 
familiar words, "waking up" as these words resonated with something deep within them. 

Along with some of the anticipated responses to the survey questionnaire, there were 
some revelations, particularly in regards to the clergy's struggle to come to terms with 
authentic Christian community when Alzheimer's disease and other forms of dementia 
are present. Most clergy, for example, found little difficulty in discussing some of the 



58 



practical matters around care home services but, as the discussion drew closer to the 
Alzheimer's individuals themselves, there was a higher level of discomfort. Nearly 50%, 
for example, used phrases such as "only consecrating the elements during the service 
when there was a clear sign that the physical state of the person was ok". Other clergy, 
52%, remarked that they chose not to consecrate the elements and instead use reserved 
sacraments because it was more 'convenient'. A high percentage also felt that keeping the 
service shorter was a necessity because of the care facility's own scheduling concerns. 
These observations give the appearance of needing to do the ministry as quickly and 
efficiently as possible. 

Language usage was an interesting factor in expressing personal levels of comfort on 
the part of the clergy. Several times the care home residents, and specifically those who 
were known cases of Alzheimer's patients, were often referred to as "old dears" and 
"precious old folks". Some clergy commented that the 'ministry of presence' is not 
specifically appreciated as family and friends often assume that 'old Sally' and 'old 
George' may not recognize those who may be visiting, or they may even have difficulty 
grasping their immediate surroundings. One survey questionnaire even referred to the 
residents as 'inmates'. 

There were additional interesting insights. In the last segment of the survey, this 
question was asked, "Overall, how would you rate your effectiveness in doing ministry 
with persons who have Alzheimer's disease and other forms of dementia?" Of the clergy 
responding to this question, many felt that they were effective in this area. However, their 



59 



answers to the following question, "On a scale of 1-10, what is your comfort level in this 
area?", revealed that the level of comfort was relatively low as if to suggest that a 
struggle, on the part of clergy, in this area of ministry is "ok". Finally, when the clergy 
were asked if a 'model of ministry' would be helpful to them, a few felt that they could 
benefit by being shown "a more effective way of reaching people", but most were more 
positive about the idea of a 'workshop' in this area, especially one available to laity and 
pastoral care volunteers. 

These responses, I believe, are very telling. First of all they indicate a certain level of 
discomfort felt by people who minister in Care Home Facilities, particularly if some of 
the residents have forms of dementia. To some degree, this is understandable as not 
everyone believes themselves to have the specific gifts required of this ministry. 
However, this survey raises some very important issues around our understanding of 
personhood as it relates to our journey with the Alzheimer person. This journey should be 
one of solidarity. Our Christian vocation is to come alongside persons who are frail and 
infirm, reminding them, through the various gifts we offer, that they are expressions of 
God's presence. Not only do they name their present reality, they remind us of our own 
value and worth as human beings. Unfortunately, when the focus is on 'time frames' in 
worship, the power of the gifts is lost. Our constant call, as clergy and other leaders in this 
area of ministry, is one of accepting the challenge to move beyond forms of worship that 
we can use so that we can connect with people, and instead, cultivate a willingness to 
enter into a conversation that speaks of our common journey. Furthermore, we need to be 
aware that this journey involves a 'ministry of presence'. An intentional choice has to be 

60 



made to walk alongside those who are frail, rather than relying a 'program or workshop' 
in the hopes it will alleviate "the problem" and absolve us of having to engage. 

As I place these observations alongside an attempt at creating an effective model for a 
Eucharistic rite for persons with Alzheimer's disease, one thing that stands out clearly is 
the need to see both the gifts of the church, and its leadership as being elements for life 
enhancing change. For this to occur there must be a visible willingness, on the part of the 
clergy and leaders, to stand in solidarity with care home residents. It is one thing to offer 
suggestions about the specifics of hymns and readings, and to pursue a liturgical model 
that allows a service a "natural flow" so that participants might have a spiritual 
experience. It is quite another thing, however, to allow the various gifts - whether they 
happen to be ritual, prayer, music, or the Eucharist - to be conduits through which the 
frail might express something of their needs and their abilities to the wider community. In 
the past there have been many well thought-out liturgical models proposed which have 
focused on the specific elements in an 'Order of Service'. These models have relied on 
suggestions regarding the length of service, the simplicity of the hymns and readings 
selected, and possible suggestions for parameters for preaching. These models do not suit 
our purposes. Our primary concern is reconnecting with liturgical forms that help us make 
sense of our reality so that our experiences of "life" can be legitimized. This is a model 
based on the Eucharist. David I. Kertzer in his article entitled "Legitimacy and 
Mystification", would mirror this understanding by stating that "the gifts of the church 
that are reclaimed are important events of channeling emotion, guiding cognition and 
organizing social groups. In so doing they claim to be powerful illustrations within the 

61 



life of ecclesiastical communities"." 50 ™ 

One way of giving support to this model would be to revisit the historical roots of the 

Eucharist, seeing it as the agent change it became when Jesus first introduced it to his 

disciples. For our purposes, we will focus on the words of institution in the Canadian 

Book of Common Prayer. 

"... who on the night that he was handed over to suffering and 
death, took bread and gave you thanks, saying, 'Take, and 
eat: this is my body which is broken for you '. In the same 
way he took the cup saying, 'This is my blood which is shed 
for you. When you do this, you do it in memory of me... " XXXVI 

These words, or variations of them, have played a formative role in the church's 
history of providing the central meal for its followers. These words allow a glimpse of the 
world Jesus entered; that transformative movement of God which occurred to bring hope 
and liberation to all people. The Gospels remind us that this Eucharistic meal, this bread 
and this wine, was the final nourishment Jesus shared with his disciples. It remains a 
reminder of his everlasting presence and the freedom won through his selfless sacrifice. 
These words also reveal the deeper reality of the mystery of the church as a Messianic 
movement called out to assist in this liberation work for the freedom and hope of all 
persons. 

From this we can clearly see that the original intention of the ritual of the holy meal 
was not solely about providing early believers with a 'strengthening symbol' or to 
identify a 'gathering point' on which to build a support network for the church 
community itself. The world that gave birth to this Messianic society was one heavily 



62 



influenced by Jewish and Greco-Roman ruling classes who had specific political, 
economic, and religious agendas that were often pursued at the expense of the common 
person. Various personal freedoms and rights were at stake in the face of these dominant 
cultures. The introduction of the holy meal was also an intentional counter-culture action 
radically different from prevailing social practice, and meant as an alternative model to 
the values of the predominant culture. 

Under the influence of Jesus' teachings, this Messianic movement began its efforts to 
turn the tide regarding the practice of social stratifying, offering a new and progressive 
approach - seeing all human beings as persons of value and worth. It was a radical 
departure from the fundamental nature of the established sociological order of the day. 
As Larry Miller describes for us in his book, The Church as a Messianic Society , the 
earlier Christians provided an atmosphere differing from the social norm and engaging all 
aspects of life. According to Miller, it provided "alternative peoplehood, alternative 
friendship, alternative family, alternative politics, alternative economy, alternative 
education, alternative ritual, and alternative festivals... hence, Messiah's followers were 
to live life in another manner than it was normally lived in macro-society". xxxvu 

Rapid development of early Christian communities saw this new "alternative" way of 
living become, as J. Hoekendijik describes it, a centrifugal mission. This word is 
descriptive of what happens when a close-knit community begins moving in an outward 
direction, thus allowing for its influence to reach the widest possible spectrum. Jesus' 
mandate would not allow early Christian communities to be inward looking social 



63 



networks, functioning on a level of survival and building walls between themselves and 
the rest of the world. Instead, they were called to take the message of light and life into 
the darkest corners of the known world. Their sharing of the Eucharistic meal provided a 
much needed model of hope for a broken and dying world. In his article entitled, "The 
Church Inside Out", Hoekendijk suggests that the initial community "leaves Jerusalem 
and the Jewish group and is on its way to the ends of the earth and the end of time. To 
join means here: to join the journey away from the centre. The symbol is the light for the 
Gentiles, which goes forth toward the people, seeking them out and taking them by 
surprise in their darkness' 



_?? XXXVlll 



Once the early church was established, around the middle to the late second century, 
the practices and purposes of the Eucharistic rites came into question. This was partially 
due to the struggles being experienced by the church as it attempted to define 
ecclesiastical powers, the ordering and responsibilities of its clergy, and the church's role 
within the rest of society. The age of the centrifugal mission that Hoekendijk referred to, 
appeared to become stifled by institutional roles and ecclesiastical polity. What was once 
a means of offering liberation was quickly coming under the threat of becoming a captive 
of legalism. Restoration meant an intentional return to the original intentions of Jesus' 
holy meal. 

Reflecting on the formation and evolution of the Eucharistic rite, reveals a struggle the 
church has remained engaged in to this day. The Eucharist of the original Messianic 
movement was seen as having the power to change the human situation and offer hope 



64 



and promise to a people living in times of adversity and uncertainty. As one revisits the 
church's mandate to offer freedom and wholeness to all people, one is called to reflect on 
the effectiveness of such gifts, particularly as they speak to the needs and concerns of 
modern day communities. The responses to the survey questionnaire reveals this tension 
wherein the power of the gifts of the church is seen as being diminished due to a chasm 
that has been created between ourselves and the people to whom we minister. 

We must ask whether or not present structures and models speak to the reality of our 
ageing population, and particularly to those suffering from forms of dementia. As 
"church" we are called to stand in solidarity with those who have become a part of the 
marginalized segment of society. Do our practices, in regards to our use of the gifts of the 
church, bring us in line with the original mandate first introduced by Jesus, of offering 
both hope and liberation? Do our present liturgical rites embrace and acknowledge the 
life and value of the elderly-infirm person, particularly those who suffer from varying 
degrees of Alzheimer's disease and forms of dementia? Our experience and research 
reveals we do otherwise. Instead of affirming the ageing person and providing protection 
and support against societal views on the infirm, our practices appear to focus on the 
sacrificial, the elements of the ancient rites that strongly suggest "salvation as a past 
event - thus, once and for all", so that persons in their present journey can find little, if 
any, hope while they remain alive in this world. Salvation, therefore, is only seen as a 
"future event", available in the after life, but not now. Not unlike the struggling second 
century church as it attempted to understand the place and purpose of the Eucharist, 
today's church gives more weight to the role and power of the clergy instead of the gift 

65 



and the value of the individual. Is it any wonder why, in our present faith communities, 
there is such a thirst for renewal and hope for people who are marginalized? 

Keeping these questions in mind, let us now focus on the model of ministry. To assist 
with this, we will use two local care home facilities in the city of Campbell River where I 
presently have pastoral oversight; Sunshine Lodge and Yucalta Lodge. These two 
facilities fall under the governance of the Vancouver Island Health Authority, an agency 
of the province of British Columbia's Ministry of Health. They provide long term care for 
approximately 200 residents, many of whom suffer from varying degrees of Alzheimer's 
disease and other forms of dementia. As an agent of change in these settings, the design 
of an appropriate Eucharistic model could not be begun without a glance into the 
'physical world' of the Alzheimer individual. What do these institutions look like? As one 
enters either of these two facilities, one is struck by the fact that one has entered into an 
institution designed for the care of persons with chronic health concerns. The interiors of 
both buildings have been painted off-white or near yellow in the hopes of giving the 
impression that they are less of an institution and more of a home for their residents. 
Along the corridors one can find the typical accumulation of therapeutic equipment 
including wheelchairs and lifts needed in order to make that transition of each resident 
into the daily routine of activities as easy as possible. Most of the walls contain pictures 
of nature and scenery reflective of the local community. There are several pieces of native 
artwork on display in the common room at Yucalta Lodge, for example, that 
acknowledges Campbell River's First Nations Community. There are also several wood 
carvings of the pacific coast salmon situated on the fireplace mantle-piece, reflecting the 

66 



city's long history in the fishing industry. The walls in Sunshine Lodge are also covered 
with a variety of pictures, many intentionally seasonal thematic celebrating Thanksgiving 
Day, for example, or Easter. Because this facility offers various art and craft classes, 
pieces of the residents artwork are also put on display just outside the main dining room 
area. 

In addition to the general domestic features of these two care home facilities, one finds 
other ways in which residents are made to feel "at home" and still connected to their pasts 
and their families. This has to do with the residents individual rooms, where they spend 
most of their time. Visiting the living quarters of a parishioner named Bill (not his real 
name) it was obvious to me that Bill's wife had gone to a great deal of effort to have his 
room resemble the home in which he had spent so many years. It was interesting to see a 
collage of family photographs, celebrating various stages of their lives together, hung on 
the wall just next to his bedside table. There was even a picture of Bill in his former 
working environment, a local woodworking factory, where for 35 years he used his gifts 
as a carpenter. 

Overall, one of the major impressions that one gets upon visiting either of these two 
care home facilities is that a real attempt has been made to create, for the residents, a 
homely environment that is both comfortable and familiar. In spite of this, as both are 
government funded Health Authority facilities, one is also aware that these are still 
"hospitals" with many of the typical reminders of the sterile environment that have been 
part of the recognisable hospital atmosphere for decades. One cannot get away from this 



67 



reality. 

As much as an attempt has been made to make the world of the Alzheimer and 

dementia person as "normal" as possible for the residents of these care facilities, we are 

still faced with the challenge of seeing how things "really are" for most of them. Jean 

Clayton, in her book entitled The Tiny Red Bathing Suit of Mr. July offers helpful 

insights into some of the realities of limitations on choice for persons entering long term 

care facilities, even if they are modernised as are the two I described. She describes these 

as losses of the human condition. When people come into a care home, particularly those 

who have forms of memory loss 

"there are further losses: privacy, their home environment, 
and, to a large degree, access to their family. They may be 
required to wear diapers and take laxatives or enemas on a 
regular basis. They may be moved from bed wheelchair by 
being swung through the air on the canvas sling of a Hoyer 
lift. Residents may be given medication without discussion, 
including tranquillisers or sleeping medication. Their choice 
of meals may be limited or non-existent. If they cannot feed 
themselves, they may be fed too quickly by too-busy staff, so 
that eating becomes stressful rather than pleasurable. They 
have to go to bed and get up at the convenience of others. 
They may or may not have a TV, radio or telephone available 
to them. They may have little or no influence on the 
temperature of their room, and must depend on the kindness 
and patience of others, for almost everything. Having a cup 
of tea when the mood strikes, or getting up to watch a 
favourite program on TV and eat buttered toast when they 
can't fall asleep becomes a wild and unlikely dream". XXX1X 

Jean Clayton's words are worthy of our reflection as we search for a ministry model 
which mirrors the early Christian community's attempt to live out the mandate of a 
Messianic society. She reminds us of some of the harsh realities people face once they 



68 



succumb to the world of Alzheimer's disease, and when they end up living out their days 
institutionalised. Due to the severity of the disease, and the fact that they require a level of 
care few families can provide, many have no choice but to accept placement in these 
facilities as soon as space becomes available. Furthermore, as individuals move through 
the phases of neurological impairment, it is taken as a given that they can no longer speak 
for themselves nor can they make decisions that would effect their own lives. They 
become a people who have no voice. Clayton's work is valuable for another reason, as it 
gives us permission to speak about the real lives of real people. She reminds us that those 
who are institutionalised are not simply people that have no past or history. Rather, they 
are living, breathing human beings who have families of their own, and who have done 
much in their earlier journeys to contribute to the society we continue to enjoy. 

Perhaps these powerful reflections of hers offer a key to opening up the gift of the 
Eucharistic liturgy, bringing it closer to the intents and purposes of the holy meal of the 
original Messianic movement as taught by Jesus. Reconnecting with the idea that original 
faith communities understood the power of liturgy as a conduit to the creation of a 
counter-culture society, one might draw the conclusion that such Eucharistic practices 
were designed to speak out against the injustices of the day while reminding the wider 
community that all persons were to be seen as having value and worth. Raphael Avila, in 
his article "Worship and Politics", offers that "the power of the Eucharist is to be found 
through a measure of crises or judgement that it evokes within the given society. 
Whenever a Eucharist is celebrated, there is a challenge being made to the church to 
recognise a profound event going on in the lives of people, that the injustices and 

69 



oppressions within the wider community have now been uncovered". The action of 
provoking a crises through this "uncovering" by way of the Eucharist, is a form of truth- 
telling. Situations thought hidden, are revealed in the light of the Eucharist Avila further 
offers that the Eucharist, "has to be seen as an intentional political sign so that its 
members vis-a-vis the church - will recognise the relationship between the church itself 
and the various socio-political forces that are in power at any given time". 

Avila' s article sites the example of the work of several bishops within the Latin church 
in Central America who were taking a critical look at the influence of the Eucharist as it 
is lived out in many of the local parishes. The Latin bishops came to believe that the 
Eucharist was seen to have qualities that were two-fold. First, there was a direct link 
made to the memorialising of Jesus' passion and suffering. When, for example, Jesus said 
to his disciples the words "do this in memory of me", it was to invoke the understanding 
that God had entered the world as one who had come in the form of the suffering servant, 
making the declaration by taking the journey to the cross. Second, they saw the Eucharist 
as being an expression of a progressive movement in peoples' lives. In essence, the 
Eucharistic rite also has a quality of being eschatological. As Jesus was raised up on the 
third day, the Eucharist further awakens people to the reality that they too are 
participating in the eschatological workings of God as a people who have themselves 
been raised up. According to the bishops in Avila' s study, this is the meaning of Jesus' 
words in the Gospels, "God has raised Christ from the dead, and also therefore all who 
believe in him. Christ, actively present in our history, foreshadows his eschatological 
action not only in the impatient zeal of humankind to reach total redemption, but also in 



70 



the conquests that, like prophetic signs, are accomplished by human action inspired by 
love" ^ It became obvious to the bishops that the people of God, in Latin American 
communities endured years of oppression and abuse under European domination. What 
has come out of this, however, is that the Eucharist became a visible sign of hope for 
these people, by making their history of oppression a truth revealed. Hence, the crises or 
judgement is made known. 

The work of Rafael Avila challenges us to see a similar power within the Eucharist 
whenever and wherever it is celebrated. In a local context, how would the language we 
use when celebrating the Eucharist provoke a crises or judgement statement within the 
present structures regarding the common needs and concerns of the elderly? Are there 
components in the liturgy that speak directly to the socio-political forces governing our 
world and forces whose action, or lack of action, could have a direct impact on our ageing 
population, particularly those who are institutionalised and suffering from forms of 
dementia? 

Having raised these questions, we are ready to take the next step and consider a model 
of ministry, in the form of a Eucharistic rite, that would call the church to stand in 
solidarity with the residents of care homes, to uncover their truths, and to give a voice to 
the voiceless. What would this model look like? How would it be representative of the 
life and community of persons who live in Yucalta Lodge and Sunshine Lodge? How 
would it both offer itself as a sign of hope and as an opportunity to raise a crises or 
political statement to the wider community? This is our attempt. 



71 



A SERVICE OF HOLY EUCHARIST 

For use in Care Homes and Institutions 

Opening Hymn 

Priest: The Peace of the Lord be always with you. 

People: And also with you. 

Collect: Loving God, you have made us as a people of value 

with open hearts and with desires that are known by you, 
even though we may have difficulty in sharing these truths. 
Gently offer your cleansing mercy on us through your Holy 
Spirit, that we may perfectly love you, an always know that 
we are in your service and under your care. Amen. 

Scripture Reading 

Homily (Comments or a brief reflection may be made at this time). 

Introduction to confession 

Priest: "Lord you have given us the gift of familiarity, when you have 
given your servants down through the ages, the words with 
which to offer our prayer of confession to you, and in so doing 
we can hear as well, your reminder to us of our forgiveness. We 
say these words together now: 

The Confession continues according to the standard form in the Prayer Book 

The Confession (said by all) 

Almighty God, Father of our Lord Jesus Christ, Maker of all 
things, Judge of all: We acknowledge and confess our manifold 
sins and wickedness, Which we from time to time most grievously 
have committed, By thought, word, and deed, Against thy Divine 
Majesty. We do earnestly repent, And are heartily sorry for these 
our misdoings. Have mercy upon us, most merciful Father; For thy 
Son our Lord Jesus Christ's sake, Forgive us all that is past; And 
grant that we may ever hereafter Serve and please thee In newness 
of life, To the honour and glory of thy name; Through Jesus Christ 
our Lord. Amen. 



72 



The Absolution 

"Almighty God, you have promised your mercy and forgiveness to 
all who turn to you in faith and repentance. These have been your 
words of love since the very beginning. Have mercy on us, pardon 
and deliver us from all our sins; confirm and strengthen us in all 
goodness and bring us to everlasting life; through Jesus Christ 
our Lord. Amen ". 

Hymn 

The Sursum Corda and Prayer of Consecration 

Priest: The Lord be with you 

And with thy Spirit 



People: 
Priest: 

People: 
Priest: 

People: 
Priest: 



People: 



You have invited us, as a people who are one with you to lift up our 
hearts to you. 

We lift them up unto the Lord 

You have invited us, Lord, as a people of value and worth to offer 
you our thanks and praise. 

It is meet and right so to do. 

You have called us at all times to give you thanks, especially with 
your promise that you are with us in our earthy journey. Indeed you 
are with us at all times and in all places. We therefore give you thanks, 
along with the whole company of heaven, and where you invite us to say: 

Holy, Holy, Holy, Lord God of Hosts, Heaven and earth are full of thy 
glory. Glory be to thee, O Lord Most high 



The Prayer of Consecration 



"O Lord, our creator of heaven and earth, you have 
made us in your own image and we have been made 
worthy individuals in your sight. You have created 
us as unique individuals. You have reminded us that 
through our common frailty we have a connection 
with your life and witness. As you first ministered 
with your friends, you gave them, through the promise 
of your Spirit, the knowledge that you would be with 



11 



them in every daily struggle, and that this would be 
lived out until the end of the ages. In so doing you 
have brought to our remembrance that our daily lives are 
often filled with uncertainly, but not without hope. 
In the world of limitations, this aspect of human suffering 
has become, for us, the appearance of an unwelcome 
guest. We feel the absence of what we once were. We feel 
the decline of our memories, our lack of judgement and 
changes in our learning ability. We discover things about 
ourselves that we no longer have control over. We notice 
irritability, sudden mood changes and restlessness in our 
inner being. Agitation and anxiety have now become a 
common way about us. 

Our own world now is also vastly different to what it once 
was. The pictures in our rooms, of our families and friends, 
help to both remind us that we have a sense of identity and 
a belonging to something larger. They connect us with 
those things that are familiar. Through them, we remember 
that we are living people who have had, and still have, 
lives of value and worth. They help to rekindle our past 
experiences and the contributions that we made for the 
benefit and upkeep of your world. 

We also notice the walls and other rooms of this facility 
that help us in our connection with the wider community. 
We find that they are filled with images of the creativity 
of peoples abilities, and the wooden carvings offer a 
symbol for us of our part in the local area. The carved 
West Coast salmon and First Nations Artwork say to us 
that we come from a rich heritage of a blessed people. 
Furthermore our day to day surroundings help to remind 
us that these care facilities are places where people are 
not forgotten about, and they remind us of the constant 
struggle to be seen as people of worth, and the constant 
need for the witness of this to be made known. 
Ultimately, this is the hope that you came to establish. 

Therefore, on the night in which your Son Jesus was 
betrayed and gave himself up for solidarity with 
humankind, Jesus took bread and gave you thanks, 
saying "take this all of you and eat it, this is my body 
which was given for you, and which has come to bring 
both life and hope to this hurting world" ... Afterwards, 



74 



Jesus took the cup of wine, said the blessing and gave 
it to his friends and said, "All of you drink this, for this 
cup is the fulfilment of the covenant in my blood. Those 
who do so, share in my vision for the restoration of all 
people, and offer release from bondage all who suffer. 

We give you thanks, that we can present these powerful 
signs of bread and wine as nourishment for us, and for 
the nourishment of all people who are frail. We ask that 
your Holy Spirit may enter these gifts so that they may 
become for us, the unifying sign of our solidarity with 
you, and as your church continues to witness to this reality 
in the lives of all of its people. Finally, in the fullness of 
time, may this holy meal continue to offer an ongoing 
hope that was first made known on the very night in 
which Jesus was betrayed, that every human creature 
under heaven and on earth may share in the banquet 
that you have promised, and that unto the end of the ages, 
our solidarity may be lived out in the lives of all your 
people. All glory is yours Almighty God, through Jesus 
Christ, his Son, Amen ". 

(The Administration of the Sacraments of Bread and Wine) 

Priest: Let us again be reminded of the love that God has for all of 

his servants in the words of the Lord 's Prayer, as we say together 

"Our Father, who art in heaven 
hallowed be thy name, 
thy kingdom come, 
thy will be done, 
on earth as it is in heaven. 
Give us this day our daily bread. 
And forgive us our trespasses, 
as we forgive those who trespass against us. 
And lead us not into temptation, 
but deliver us from evil. 
For thine is the kingdom, 
the power, and the glory, 
for ever and ever. Amen. 



75 



The Prayer after Communion 

"Loving God, we continue to be reminded as we have 
received this bread and wine, that we are forever in 
your remembrance, and that our day to day struggles 
are not forgotten. We also are reminded that our 
participation in this holy meal is a sign that we are 
living members of your body, and we continue to be a 
part of your church. We are therefore presented to you 
as whole, loving people in your sight who continue to 
remain in your service. Amen ". 

The Blessing "God of love and mercy, we are the signs of your 

presence in the world. May we continue to be seen 
as agents of this love in all that we do. And may the 
blessing of the God who creates, sustains and empowers 
us; Father, Son, and Holy Spirit be with us this day and 
for ever more". Amen. 

Closing Hymn 

From this model of ministry in the form of a Eucharistic rite, we can make the 
following observations. We are reminded that whenever one offers any form of ministry 
in a care home facility, one of the components is an acknowledgement of the familiar. We 
see examples of this with the mention of the surroundings of the care home and the 
articles that are spoken of in the residents rooms, both of which are in place the in the 
prayer of consecration. Experts tell us that in presenting familiar things to residents 
decreases their level of anxiety, and, at the same time, bridges many of the emotional 
gaps which often occur when people are committed to the care of such facilities. They 
find it a smoother transition when the world they are entering is as similar as possible to 
the one they have left. Some may translate this need for familiarity in their physical 
surrounding and a good argument for retaining a previously experienced order of service 

76 



the status quo anti, if you will. In many ways this tension is acknowledged in this model 
that recognises some aspects of the liturgy that are very familiar in terms of wording. This 
is why, for the most part, the responses from the residents are all taken from the familiar 
wording of the Book of Common Prayer. Furthermore, what is also being addressed in 
this model is the familiarity of the natural rhythm of the service itself. It is known, for 
example, that the absolution follows the confession, and the Lord's Prayer follows the 
Prayer of Consecration, and so on. However, in this model, making declarative statements 
within the Eucharistic rite makes space for the possibility of reconnecting with various 
forms which can help make sense of the reality around us, so that our beliefs about God 
and life, in all of its ways can legitimised. Our main intent, then to attempt to grasp the 
day to day world of the Alzheimer person, and in doing so, honour the original mandate 
of the Messianic movement as introduced by Jesus. 

What is gained, for example, from the following verse in our revised prayer of 

consecration? 

"In the world of dementia, this aspect of human suffering 
has become, for us the appearance of an unwelcome guest. 
We feel the absence of what we once were. We feel the 
decline of our memories, our lack of judgement and changes 
in our learning ability. We discover things about us that we 
no longer have control over. We notice irritability, sudden 
mood changes and restlessness in our inner being. Agitation 
and anxiety now become a common way about us. " 

Here a clear statement is being made about the real lives of real people suffering forms of 
dementia. Mood swings and altered personalities are some of the day to day realities 
faced by these individuals. According to literature produced by the "Interior Alzheimer 



77 



Foundation" of Kelowna, BC, in Canada, diverse psychological changes are a very real 
issue for the lives of those struggling with Alzheimer's disease. "The Alzheimer person 
goes through a variety of psychological changes in a given day. The individual is often 
characterised as a person with declining memory, judgement, and learning ability. 
Irritability, sudden mood changes, restlessness and agitation may become common. 
Personality changes occur with a breakdown in speech and language, increased confusion 
and inability to carry out routine personal care"." 1 " 1 The life of the person suffering from 
this disorder is impacted by monumental losses that range from personality changes to 
limitations in personal judgement. Their plight is clearly defined. 

As a model for ministry, this Eucharistic rite speaks to the issue that, in all aspects, 
human life has value. It affirms for people that their vocations, occupations and personal 
accomplishments are not lost due to the fact that they have succumb to a disease of loss 
and limitation. As the prayer of consecration in this rite suggests, every care home 
resident has a past, they each have a history. Their lives are compilations of milestones 
and events with family and friends. They have ties to the community. 

"Through them, we remember that we are living people 
who have had, and still have, lives of value and worth. 
They help to rekindle our past experiences and the 
contributions that we made for the benefit and upkeep 
of your world". 

In the final section of our prayer of consecration we find the heart of this ministry 

model. 

We ask that your Holy Spirit may enter these gifts so 
that they may become for us, the unifying sign of our 



78 



solidarity with you, as your church continues to 
witness to this reality in the lives of all of its people ". 

Just as it calls us into unity with God, so too does the liturgical work of the church call us 

to stand in solidarity with those who are suffering and marginalized. No longer are they 

voiceless. They have someone, the church, who can speak their pain and offer their reality 

as a means of judgement to the wider community. So begins this journey towards 

emancipation. 

Reoccurring throughout the framework of this new model is the mention of crises - 
something which, should one do a comparative study, would be found to be lacking in 
many of the Eucharistic rites presently in use. This leads us to question their power and 
effectiveness for our purposes. This lack of crises points to a theological shift which 
became the norm by the time of the Early Church and which is still in evidence today. 
The Prayer Book rite offers an example of this as it speaks exclusively of the sacrificial 
offering of Jesus, as it was proclaimed by God, for the salvation of the world: 



"who of thy tender mercy didst give thine only Son 
Jesus Christ to take our nature upon him, and to 
suffer death upon the cross for our redemption; 
who made there by his one oblation of himself 
once offered, a full, perfect, and sufficient sacrifice, 
oblation, and satisfaction, for the sins of the whole 
world; and did institute and in his holy Gospel 
command us to continue, a perpetual memorial of 
that his precious death, until his coming again". 



This prayer does not give weight to the eschatological co-operation that exists 
between God and humanity spoken about in the work of Rafael Avila. The Latin bishops 



79 



he wrote about suggested that Jesus' passion must also be seen as a. progressive movement 
in the lives of people. The very fact that Jesus was raised on the third day awakens a 
poignant reality in the Eucharist. When celebrating this holy meal, God's people 
participate in this event as a resurrected people. It is through this redemptive work that all 
of God's people - the church - work together to dismantle the forces that work against 
God's ultimate plan of salvation. 

One may draw the conclusion that the church which gave birth to the Prayer Book 
reveals a tension which exists even today. When one considers the Early Church, there 
appeared to be a greater acceptance to embrace the counter-culture movement established 
by Jesus which saw the work of the church as a means of promoting liberation and 
justice. Church life and ecclesiastical polity had a focal point on the common person. It 
wasn't until several centuries later, during the time of Charlemagne, that a chasm began 
to form between the institution of the church and her people. During this time the church 
became almost identical to society, making greater the challenge to work against 
oppression and to unmask forms of abuse within that society. One subtle reminder of the 
church / society integration during this period was the wearing of vestments, a 'tradition* 
clergy 'borrowed' from those in authority so that they too might be seen as figures of 
authority. The result of this was that the clergy began viewing themselves as having a 
stature similar to that of community leaders, the very people they were often opposed to 
politically. Ironically, this perception continues today. 

Our conversation around existing Eucharistic rites is not merely to draw comparisons 



80 



between past and present practices; we still must question their lack of sufficiency for 
some segments of the Christian community. A new Eucharistic rite is not made complete 
by mere mention of crises. It cannot just reveal the plight of those who suffer from 
Alzheimer's disease and dementia. Nor can it simply allude to the increasing risk to 
people unable to speak for themselves, or stripped of value and power because they 
happen to suffer from a degenerative neurological disorder. Such revelations must lead to 
action. One is reminded of how the power of the gifts of the church can easily be 
forgotten. As Rafael Avila reminds us "that there is nothing more dangerous than an 
unrecognised power, because one who has the ability to make political change without 
knowing it is an easy victim of manipulation". To forget this would be an even greater 
tragedy. 

The potential of a new Eucharistic rite becoming a vehicle of transformation was 
brought home to me through the choices and actions of a parishioner who is also 
employed as a Nurse at one of the care home facilities. Having expressed an interest in 
my work, she allowed me to share my thoughts and ideas regarding the creation of a 
Eucharistic rite that would speak to the lives and needs of the elderly and infirm, 
particularly those with Alzheimer's disease and other forms of dementia. She commented 
that, "in such a Eucharistic rite, there would be parts of the service that residents would be 
able to associate with as the liturgy stressed, to a large degree, the present moment for 
people who were in various levels of medical care". I learned, later, that our conversation 
sparked an in interest that led her to begin a campaign of letter writing to her superiors 
and local and provincial health care authorities regarding the level of care many care 

81 



facility residents are presently receiving in the province of British Columbia. Naturally, 
this was done with a high level of professionalism so as not to put her employment in any 
jeopardy, nevertheless, she felt moved to become an advocate for the patients in her care. 
At the present time, both Sunshine Lodge and Yucalta Lodge have undergone a 
tremendous reduction in funding as have many of this provinces' care facilities. There are 
concerns about understaffing and reductions in the amount of quality of the care being 
provided. On an average 12 hour shift, residents receive only a minimal level of medical 
attention, except for feeding, and the distribution of prescribed medications, and 
assistance with basic personal hygienic care to the residents. There simply aren't enough 
staff members to go around. The nurses are doing their very best, and are to be 
commended for such efforts, but they have only limited resources with which to work. 

As one would imagine, the needs of care facility residents, especially those with 
dementia, the needs are ongoing. After reflecting on our conversations about the liturgy, 
this nurse decided to advocate on behalf of two of her patients in particular. Both are 
elderly women, ages 82 and 92 respectively, and both need constant assistance as they 
spend their days in wheelchairs and are confined to their beds the rest of the time. The 
nurse informed me, however, that during a recent period of staff shortages both had been 
confined to bed, on their backs, for several days because there simply wasn't enough 
assistance available to transfer them to new sleeping positions. This resulted in one of the 
ladies experiencing an increased level of bed sores and other medical complications. 
Since my initial conversation with this nurse, every time I now enter this facility, I 
receive an updated report of how these two residents are doing. From my perspective, it is 

82 



a delight to see how my parishioner's role as an advocate has taken her to a new level of 
service in her work as a nurse in the health care system. 

Reflecting on this situation, I am keenly aware that as in the story of these two elderly 
ladies, neglect is a common problem. It is also a reminder to us of the constant need to 
both examine, and re-examine, the important gifts of the church which can be agents of 
change in the world. One wonders if the role of advocate taken by this nurse, mirrors the 
role taken by the early Christian communities who operated on counter-cultural intentions 
while following the model of Jesus offered as a way of bringing hope to the wider 
community. Her own activism, through her letter writing, was indicative of an 
understanding of the model Jesus left with us. She responded to the crises in a way that 
was voice restoring and life giving, counting the elderly and the infirm amongst God's 
valued people. In calling the rest of the community to attend to these, she was also 
reminding them that they too, as potential "ministers" in this situation, are valued people 
of God. This gentle gesture of advocacy is a real example of the gifts of the church as 
profound agents of change. "The status quo is challenged in order to provoke a change in 
thinking and action. . . .it is not to give sin an opportunity for making a formal entrance 
into society, but rather to judge it and to unmask it. If we are ingeniously unaware of the 
accused or if we refuse to judge them, this is not prophesy and it quickly dissolves the 
tension that should be celebrated. It negates hope and remains caught in the trap of 
positivism". Vl As Avila contends, responding to the prophetic crises in our common 
call. This, I believe, is what this nurse was attempting to do. 



83 



When one visits the deeper realities of the gifts of the church, one comes to understand 
that not only do they feed God's people, they also initiate holy actions. They offer what 
was at the very heart of the Messianic movement initiated by Jesus, as a way of bringing 
God's fulfilment into the present day. Exposure to this understanding reminds those 
offering ministry through their care of persons who are vulnerable and marginalized, of 
the sacred vocation to use the gifts we have been given - and use them wisely - as a 
means of offering hope to, and solidarity with, all of God's people. Furthermore, it would 
also serve as a significant step in our journey towards a deeper understanding of a 
theology of personhood. 



84 



Chapter Five 

This exploration of the world of the Alzheimer individual has been a profound and 
insightful experience. My visits with my parishioner "John", with whom I began this 
journey, and the pastoral relationships 1 subsequently developed with "Jane" and 
"Margaret", initiated question after question regarding the church's place and purpose in 
the lives of those with Alzheimer's disease and other forms of dementia. Gradually my 
search expanded to an enquiry in to the nature of "personhood" and how God affirms and 
sustains the "personhood" of the Alzheimer individual through the workings of the gifts 
of the church. My pastoral ministry resulted in opportunities to witness God's movement 
in these people's lives. In John's case, specifically when he received the Eucharist, I 
observed a change wherein it seemed as if God was revealing his nature, as a Divine 
being of ultimate love, through this offering of the gifts of the church. This led me to ask, 
"What was going on when John received these gifts?". It occurred to me that John was 
experiencing an "awakening" when he received the Eucharist. For brief periods he would 
move from a near comatose state to a state in which he became more alive. Furthermore, 
when he received the Eucharist he kept repeating the word "Amen" over and over again. 
These episodes led me to conclude that the gifts of the church provided a window through 
which effective and life sustaining ministry might be offered to those living lives being 
drained away by the diminishing effects of Alzheimer's disease and other forms of 
dementia. 

As this journey continued, however, I came to realize that the parameters of my 



85 



question were broadening. The shape of the question grew from, "What was going on?" 
to more specifically, "What was John saying when he had this experience of sharing in 
the Eucharist, or when other of the church's gifts were offered to him?" Was John 
inviting us, for example, into some form of dialogue about personhood? Was he inviting 
us into a conversation with him that informs us that degenerative disorders, such as 
Alzheimer's disease, does not constitute a "loss of self but, instead, offers an invitation 
on the part of the Christian faith community to assist in the "recovery of self? I believe 
he was. 

As well as continuing to accompany my own ministry, these questions have instigated 
reading and research that has given me new insights into the power of the gifts of the 
church and what they offer to persons suffering Alzheimer's disease and other forms of 
dementia. Some of my own observations and also those of my colleagues, have 
suggested, for example, that the gifts of the church have the ability to connect with 
people on a profound level offering, not only a renewed understanding of themselves, but 
also of the world around them. They invoke change and transformation. Others from the 
theological and academic world also echo these insights. David Hogue's book entitled 
Remembering the Future Imagining the Past: Story, Ritual and the Human Brain, is 
brought to mind in which he presents extensive research, from the perspective of faith 
communities, on the ability of ritual and other gifts to offer hope to persons undergoing 
periods of stress and trauma in their lives. In his research he cites the conclusions of 
family therapist Peggy Papp who suggests that ritual, and other gifts, can be paramount in 
helping families though life altering situations. "Ritual in all of its forms can be used 

86 



when ministering to persons not only to comment on the experience, but to actually 
change it. Since Rituals and other gifts of the church, make use of the stuff that dreams 
are made of- symbols, fantasy, myths, story telling and metaphors, they address 
themselves to the most primitive and profound level of experience". TO 

Furthermore, other fields of study would support this idea. Cultural anthropologists 
Robert McCauley and E. Thomas Lawson in their book, Bringing Ritual to Mind: 
Psychological Foundations of Cultural Forms have offered intriguing insights on ritual 
and its power through their observations of the Baktaaman peoples of central Papua New 
Guinea. During the latter part of the 1980's, McCauley and Lawson concentrated their 
work on examining the initiation rites of male individuals who, after a period of time, 
began to show a remarkable inner understanding of themselves and their own identity as 
members of the Baktaaman community. The Baktaaman are an indigenous group of 
people who, prior to the early 1 960's, had little if any contact with the outside world. 
They are a small, illiterate group who number no less than 1 80 people, and whose very 
sustainability is the result of hunter gatherer techniques and some subsistence farming. 
McCauley and Lawson observed that the Baktaaman peoples exhibited very interesting 
initiation rites for males which, when completed, bring them into full membership and 
stature within the community as men. Through this process they ascend through seven 
degrees, or levels, of initiation rites. However, because of the high level of scrutiny and 
secrecy within the group, the details of the rites themselves are somewhat sketchy. So 
secret, in fact, are some of these rites that senior members within the group threaten 
initiates with death should they violate ritual secrecy. Furthermore, not only are initiates 

87 



themselves prohibited from discussing these secrets with non-initiates, most of the time 
they are also prohibited from discussing them among themselves. 

Even working within these parameters McCauley and Lawson were still able to make 
some observations of Baktaaman ritual. In doing so they made an important discovery 
regarding the reception of rituals by the initiating individuals themselves. The initiates 
enter into what the anthropologists call a form of "analogic coding" where a message of 
understanding about one's culture is transmitted from the senior member to the initiate. 
These initiations "transform a group of young persons into men who possess a general 
area of common sensibilities and intuitions and a range of understandings sufficient so its 
members can be moved by the same symbols and thoughts. The initiations instil in the 
initiate distinctive cognitive dispositions and sensibilities concerning self, cohort, society 
and Nature". Hence, the new members attain a deeper understanding about 
themselves, each other and the world around them. A further important discovery is the 
way in which this knowledge is retained and received, particularly when one considers 
that the Baktaaman have no concept of written language within their culture for they are 
still able to derive an understanding of themselves as a people. 

Some of these insights have informed my research regarding the gifts of the church 
and their power. From my own observations, and from the experiences of my colleagues, 
1 am led to believe, borrowing the language from McCauley and Lawson, my own that 
"analogic encoding" occurs with the practices we offer. Ritual instigates change. 
McCauley and Lawson' s work also speaks to the depths reached using rituals and their 



88 



power. Quite specifically, when rituals - whether they be story telling or other - are done 
either routinely or over and over again, those who participate in them end up becoming a 
part of 'the story or script that is happening. This means, among other things, that they 
become habitual and automatic. In fact, "their memory for carrying out these action 
sequences is largely procedural rather than declarative. Participants may have a much 
richer sense of how to proceed than they have for what they are doing. Their knowledge is 
implicit". ** 

As helpful to our understanding of the gifts of the church as these observations may 
be, we must also be mindful of their limitations. When I revisit my enquiry with John and 
the others, I believe they are inviting us to see the gifts of the church as instruments of 
solidarity, allowing us to stand alongside those who have no voice. In reclaiming these 
gifts they participate in recreating community, reminding us that they are people of 
tremendous worth and value. The life giving and affirming language that is a result of 
sharing these gifts can be used as a means to identify, to the wider community, the 
profound reality of the Alzheimer person. To merely focus on the gifts as only providing 
brief experiential moments for the recipient, in this case the person with Alzheimer's 
disease, is a limited and potentially detrimental view. I am reminded of the responses of 
my colleagues on the survey questionnaire and the struggle endured while attempting to 
find a way of connecting with the Alzheimer person. At the same time, finding an order 
of service which "fits" the needs of that person. The tendency, it seems, is to concentrate 
on a means of allowing clergy to feel adequate as caregivers, but in a way that fits within 
a prescribed time frame, in order to keep the service as brief as possible. Because, 

89 



according to the voice of my colleagues, keeping it short is vital. The other struggle I 
encountered with was the request for programs and workshops which would help people 
learn more about ministry to persons with dementia and so on, which seem to suggest that 
we can do effective care and ministry from a distance. 

To be sure, this may be a normal response to feeling uncomfortable especially if one 
does not enjoy such pastoral work in institutional settings. Yet this suggests a serious 
contradiction for the church because it speaks very clearly to the nature of personhood 
as a journey in community and the need to find authentic ways of being community. In 
many ways, John, Margaret and Joan have been instrumental in helping us formulate this 
understanding. When T reflect on their personal stories, I reach the conclusion that they 
have been inviting us into a dialogue that embraces a sense of "The Other". In our earlier 
chapters we noted the parameters that defines 'the others' in our society. They are those 
in our communities whose context is formed by persons holding positions of authority 
and power. They are the individuals or groups who are powerless and who others can 
systematically marginalize or oppress. The stories of John and Margaret and Joan invite 
us to enter their reality so that we might have a fuller understanding of the human 
condition. How might this be? Quite simply, their invitation is a call for persons to be 
vulnerable with one another. Seeing and accepting each other as full sisters and brothers 
engaged in the same journey. 

In many respects it is easy to see the vulnerability in their stories. John endured a 
myriad of losses due to his entrance into the final stages of Alzheimer's disease. He 



90 



experienced a loss of cognitive function. He was unable to feed or dress himself. He also 
reached the point where he was unable to speak or smile. Margaret also went through a 
variety of losses. She struggled to find and maintain her place in the church community, a 
place now in jeopardy as a result of being clinically diagnosed with dementia. Jane's 
story was another path paved with losses. In her case it was 'language-statements', based 
on her age, that were becoming a determining factor in her ability to offer her gifts of 
music to the church. At the heart of our journey towards the practice of authentic 
ministry, however, is a call for a renewed vision of vulnerability - for all people. To be 
receptive, to be open to others and to be open to life requires a certain amount of 
vulnerability. We need to be honest about our fears, our thoughts and feelings. We need 
to speak of our own losses and failures. We need to speak with a sense of integrity about 
our dreams and our passions and our ideals and place them alongside our core values and 
what we believe about God and life. The philosophy of Levina mirrors this when he 
suggests that "subjectivity is vulnerability, it is having an exposure to 'the other' at the 
deepest possible level". 1 For any level of closeness, or for any authentic connection to be 
made, we need bo, vulnerable in the face of "the other". 

This ministry of vulnerability, as Hubertus Ernst points out in his article "On Being 
Human and the Human image of God", has scriptural support. We read, for example, the 
Apostle Paul, in his letters to the early Christians in Corinth, addresses the question, 
"What does it mean to be truly human?" Earlier on, Paul's experience had taught him that 
he was not able to make the radical attitude of service that Jesus had taught - a service 
unto death, even death on a cross - understandable to people. In Paul's own words this 

91 



concept seemed foolish to him. This was also the reaction of Jesus closest followers when 

Christ began this mission. The Gospel reminds us that even his family members and 

friends wanted to seize him and bring him back home because they felt he had gone out 

of his mind. Therefore, Paul offered a reflection on the subject which speaks to the 

"folly" of Jesus in contrast to the "wisdom" of the world, and accordingly we know God 

through this folly. Hence, the foolishness of God leads to the wisdom of God - a wisdom 

not comprehended by the those in authority at that time. As Ernst points out in his article, 

Paul also speaks in this context of God's weakness, calling the weakness of God, or the 

vulnerability of God, as stronger than human strength. 

"For the message about the cross is foolishness to those 
who are perishing, but to us who are being saved it is 
the power of God. For it is written, 'I will destroy the 
wisdom of the wise, and the discernment of the discernment 
I will thwart '. Wliere is the one who is wise? Wliere is the 
scribe? Where is the debater of this age? Has God not 
made foolish the wisdom of the world? For since the world 
did not know God through wisdom, God decided through 
the foolishness of our proclamation, to save those who 
believe ". 

(1 Corinthians 1:18-21, NRSV) 

As one can see, this further opens our dialogue, possibly providing a partial answer 
of what it means to be "truly human". Ernst goes on to say "we could say in this context 
that what seems foolish is in fact human. We could say moreover, that it is foolish and 
human for the same reason: foolish, because it is contrary to the self-centered striving for 
being (conatus essendi) as the philosopher Levinas once explained. Yet, human, because 
it is changing life from self-centeredness to dedication in response to the demand of the 



92 



Face of the Other, making the conscience-driven choice to be a neighbor to the other." 
As Ernst would suggest, the ideas behind the writings of Paul seem far removed from real 
life but, when one looks at the interactions we make within our world, we find we can all 
can place ourselves in this picture Paul paints for us. After all, "does not everyone of us 
know moments when we say: what I have done is foolish, but I could not do otherwise? I 
had to doit". 111 

This dynamic is played out in the affairs of everyday life and at the heart of it, is the 
conscious shift we make in order to widen our intentions to connect with the other. It is 
the movement from a self-serving perspective, to one of placing others within our field of 
vision. In other words I must be willing to place my own agendas and assumptions aside, 
and acknowledge my own fears, with the hope of gaining a deeper sense of the journey 
being experienced by those to whom I minister. I must be willing to have an exposure to 
the other at the deepest level. This, no doubt is one of the great tensions of all who 
honestly strive to be engaged in areas of pastoral ministry. It calls us to move beyond 
our own comfort levels, even laying aside our own assumptions of ministry, in order to 
communicate a Christ-centered model of freedom and liberation for all people. As 
suggested earlier, the danger is in the failure to see this. For me, a profound insight 
attained in this journey has been the discovery of my own assumptions when entering 
institutions to offer care to persons with Alzheimer's disease. My initial observations, of 
what I witnessed happening to John, led me to see the gifts of the church in a way that 
was, for the most part, clerical centered. I saw that John responded whenever the 
Eucharist was offered and because I was the ritual practitioner and had the means with 

93 



which to offer the sacramental presence to him, it would have been an easy step to 
assume that I enabled John to have this encounter with God. In retrospect it was also seen 
as an occasion of "the church" going in and doing the function of ministry so that it could 
somehow validate the effectiveness of the church in that ministry. 

How did assumptions inform pastoral ministry in these critical encounters? They 
caused the ministry experience to stall at "provisional" rather than allowing it to progress 
to relational. It gave the impression that we have the gift of the church and we are in 
control over the given situation, and we have the means with which to dispense this gift 
so that they will experience God's presence. One can see the danger here. It is reminiscent 
of clericalism that is supportive of structures where someone has power over someone, 
and uses it in this manner. Historically speaking, this has been a recognized struggle for 
the church and, due to our ignorance, it has resulted in broadening the rift between those 
who "minister" and those to whom we've been called to minister. This raises questions 
about the mutuality of our encounters or, to use Ernst's words, making the conscious - 
driven choice to be a neighbor when faced with the Other in all of its manifestations. 
Ministry becomes mutual when we invite relationship to unfold. 

What might John and Margaret and Jane's stories be revealing? What might they be 
saying to us? They may be challenging us to change our perspective and adopt theirs, for 
a time. In our society there are many people who operate as if they are on the outside 
looking in. They are not seen as full members of the community because the community 
has placed them into categories of powerlessness based on class, creed, orientation, 



94 



gender, ability, colour or age. In asking us to place ourselves in their positions - we 
discover the struggle of maintaining one's belonging in community and the struggle to 
maintain a sense of "self ' in the face of diminishing language statements. John and 
Margaret and Jane are reminding us that they belong, as we do, to God, and to the family 
of God. They are part of the community, based on being-in-relationship, as we are part of 
the community. They are saying do not forget this. This brings me back to my own 
"awakening" to the depth and breadth of pastoral ministry through the gifts of the church. 
The very thing these people are witnessing to the church - or perhaps, more specifically 
to me - is the need to reclaim our mutual humanity, which is rooted in God, and to 
reclaim our relational community, which is centred on God. 

In my quest to understand the nature of personhood, I came across a story, in an article 
by John Swinton, that I feel compelled to share. It is a powerful illustration of the human 
need, and longing, to be-in-relation all of our days. The story is told as seen through the 
eyes of Margaret Hutchison, a Care Home Nurse. 



"An elderly lady suffering from dementia, paced the corridors 
of the nursing home restlessly - repeating over and over, just 
one word. The staff was disconcerted, but no one seemed quite 
sure how to calm her and put her mind at rest. In fact they were 
at a loss to understand the reason for her distress. The word she 
repeated over and over again was God- and that was all she 
said. One day a nurse got alongside her and walked with her up 
and down the corridors until eventually in a flash of inspiration 
she asked the lady, "Are you afraid that you will forget God?" 
Yes, Yes! she replied emphatically. The nurse was then able to 
say to her, "You know even if you should forget God, He will 
not forget you. He has promised that." For this lady who was 
forgetting many things, and aware if it, that assurance was what 
she needed to hear. She immediately became more peaceful, 



95 



and that particular behaviour ceased. She was responding 
positively to care which extended beyond the needs of the body 
and mind - care of the human spirit". lui 



This poignant story, of an elderly woman's struggles in the face of dementia, is a 
wonderful parallel to the story of my parishioner, John. Yet, this story also reveals a 
profound revelation about this sustaining love of God which reaches beyond memory and 
beyond our ability to communicate in a way that is cognitively understandable. We are 
indeed persons called to be-in-relation and, in many ways, who we become is often 
shaped by the very people we encounter. But, as Swinton reminds us, this identity has a 
greater dimension, "ultimately our identity as persons, our hopes and possibilities for the 
future, is determined and sustained by God who, in Christ is with as and for us even, and 
perhaps particularly in our darkest hour of need. Even when all of our faculties are taken 
from us, we remain persons-in-relation through God's continued desire to relate to us, to 
minister to us and be with us now and for ever more. This is an inevitable and beautiful 
consequence of being made in the image of a Trinitarian God who is pro me. " uiv This is 
what it means to be human. 

Again we may further wish to ask, what does this image look like? Looking through 
the eyes of those with dementia the quest of this sacred journey thus far, has required an 
acknowledgement of the severity of losses often accompanying this disorder. Many 
schools of thought have produced a litany of losses which a person can look forward to 
should they happen to succumb to Alzheimer's disease. We have reflected on loss of 
cognition, loss of mobility and in most cases, severe loss of memory. In addition, earlier 



96 



schools of thought have adopted a definition of "being human" based on cognitive levels 

as measured by the Stanford-Benit intelligence ratio. Still others have influenced our 

understanding of being human through biomedical profiling. One recalls reflections, 

encountered earlier in our search, in this paper, from persons such as Joseph Fletcher, 

who described the basis for personhood. 

"To be a man we must be capable of self-awareness, self-control, 
have a sense of time, futurity and past, be capable of relating to 
others, show concern for others, be able to communicate, exert 
control over our existence, be curious, be open to changes, have 
proper balance of rationality and feeling, and have a unique identity. 
Negatively, men are not any of the following: anti-artificial, 
essentially parents, sexual, worshippers, or a bundle of rights". 

These cognitive and biomedical based approaches determine our eligibility to belong 
and our value as persons by measuring abilities against perceived disabilities. The 
theological discovery of person shood, however, does not. Instead, we move away from 
losses and the potential loss of self - towards the rediscovery of self- through a renewed 
understanding of the presence of the Divine. We see this being lived out countless times 
in our faith story. Scripture reminds us of encounters that God has had with his people to 
remind them that their journey does not take a solitary route. When Jesus said, in the 
Gospel of John, "Behold I have come that they might life, and have it in abundance" it 
was a reminder, for those who often find themselves on the fringe of society, that they 
still have a place with God. One could also offer that such a place is found "here and 
now", within the embrace of a living community of faith that operates and lives out its 
practices in accordance with this Divine mission. 



97 



A similar message of hope may be found in the final verses of that same Gospel. Here 
we discover a truth that resonates clearly from a God who is with us. In verse 21:18-19 
Jesus is says to Peter, "Feed my sheep, I tell you truth, when you were younger you 
dressed yourself and you went where you wanted; but when you are old you will stretch 
out your hands, and someone else will dress you and lead you where you do not want to 
go". Jesus is prophesying the eventual circumstances of Peter's life, prior to his death. 
Yet, we also can see this as a reflection of the circumstances of those who reside in the 
world of dementia. When it is no longer possible for us to serve God in the manner in 
which we once did; when we can no longer even remember who God is or what God has 
done for us in Christ, God comes along side us and ministers to us in our weakness. 
Furthermore, our faith journey has reminded us that underneath these truths is the 
reminder that God coming-to-us in our weakness does not occur as some form of reward 
for meritus service - for this would remove us, then, from a personhood based simply by 
being. 

We have a hope that has moved us beyond this perception. It is found in the very life - 
force that bases our identity in the way of love. Again, John Swinton offers additional 
substance to this Good News by reminding us that the acknowledgement of our 
personhood is "a return to the understanding of an act of Graceful friendship. The 
inevitable outcome of Christ being pro me in ways that cannot be destroyed by the 
ravages of time or disease, furthermore which also cannot be measured through some 
other non-divine means. . . .God's coming to us in our weakness, His remembering us 
when all seems to have been forgotten is an inevitable outcome of his essential nature as 

98 



Christ-for-us, Christ pro we." lv 



In light of these reflections it would seem that the most natural "next step" would be 
to reconnect with this proclamation. In our journey to find a deeper way of caring for 
persons with dementia we have found that their sense of personhood is reclaimed and 
sustained through meaningful relationship with God. It is also sustained, however, 
through other persons . This is the very theological foundation which assists us in our 
daily encounters with life and all of its wonders, and is no less so for the person with 
dementia. We become, come-to-be, persons through our relationship with God and with 
one another despite disease or disorder, despite loss or impairment. The very care offered, 
if it is to truly to be called "care" - must be shaped by this reality. This is what brings us 
into the realm of authentic personhood. 

The power of this reality, however, is only activated when it is lived out. The Christian 
tradition has a rich history of being able to offer levels of care and outreach to those in 
need. We have seen the church take an active role in health care systems, and influence 
societal mandates regarding the care and support of its citizens. Furthermore, the church 
maintains that, in Christ, God has come among us with the renewed mission that God's 
Kingdom is not only a future reality, but here now, in its full expression, for the whole 
human family. This is our hope and belief. However, this hope must find expression in 
our practice, particularly in face of society's ever present reality of people feeling as if 
they've been forgotten by us, or worse, forgotten by God. This is where we have 
something to offer, the reacquaintance with what it means to be human; specifically, the 



99 



entering into a place of recognition, respect and trust for each other. In this understanding, 
personhood is not a personal attribute nor does relate to the presence or absence of a 
particular function. Instead it is the product of a particular relationship encounter - 
between ourselves and the living God. 

The questions that have informed my journey have been posed in light of profound 
relationships with remarkable people who happen to suffer from a very strange and 
difficult disorder. Their journeys have been fraught with uncertainty and have put 
tremendous emotional strain on family and friends. In seeking answers to my questions, I 
was invited to witness their personal struggles to maintain some form of connection with 
the very pulse that gives them life. Though our walks have differed, our journey's 
destination has been the same - to know where our place is and who we are in the midst 
of that. We achieve this by allowing one another to remain as viable members of the 
Christian community and to have the expression of that lived out through faith in the 
Triune God. A path that leads to personhood, and a sense of self, cannot exist without 
each other. As Archbishop Desmund Tutu once said "A person is a person though other 
persons. I am human because I belong". The personhood of all people in an ever present 
reality - even in the world of dementia. The relationships we establish, the hope we 
proclaim, the shape of the liturgy, and the reconnection to the power of the various gifts 
of the church all help to facilitate this. May this journey continue. 



too 



Endnotes 



1 Anglican Church of Canada, The Book of Common Prayer : And Administration of the Sacraments and 

Other Rites and Ceremonies of the Church According to the use of the Anglican Church of Canada : 

Together with the Psalter as it is Appointed to be Said Or Sung in Churches : And the Form and Manner of 

Making, Ordaining and Consecrating of Bishops, Priests and Deacons (Toronto: Anglican Book Centre, 

1962), 84. 

a Ibid., 84 

111 Stanley Hauerwas, "The Retarded and the Criteria for the Human," Journal of Religion, Disability & 

Health 8, no. 3-4 (02 2005): 127. 

lv Marianne H. Micks, Our Search for Identity : Humanity in the Image of God (Philadelphia: Fortress 

Press, 1982), 65. 

v Margaret Ruth Miles, Fullness of Life : Historical Foundations for a New Asceticism, lstd ed. 

(Philadelphia: Westminster Press, 1981), 64. 

Vl Hauerwas, The Retarded and the Criteria for the Human, 130. 

™ Ibid.: 131. 

™ Tbid.: 128. 

IX Saint Bishop of Hippo Augustine and G. Wills, Saint Augustine's Memory Viking, 2002), 12. 

x David Hogue, Remembering the Future, Imagining the Past : Story, Ritual, and the Human Brain 

(Cleveland, Ohio: Pilgrim Press, 2003), 55. 

M Daniel Kuhn, Alzheimer's Early Stages : First Steps in Caring and Treatment (Alameda, Calif. : Hunter 

House, 1999), 11. 

*" Bryan Kolb and Ian Q. Whishaw, Fundamentals of Human Neuropsychology, 3rdd ed. (New York: 

Freeman, 1990), 4. 

*" William Molloy, Paul Caldwell, and Canadian Medical Association, Alzheimer's Disease (Toronto: Key 

Porter Books, 1 998), 6. 

** Ibid., 57. 

™ Ibid., 57. 

™ Ibid., 9-10. 

xv " "About Alzheimer's Disease: Research - Caregiving - Treatment - Publications - Risk Factors - 

Resources - Symptoms - News," [cited 2008]. Available from 

http ://www . ahaf. org/alzdi s/about/adabout . htm . 

XVIU "Stages," [cited 2008], Available from http://www.alz.org/espanol_stages.asp. 

MX W. Shakespeare, W. G. Clarke, and W. A. Wright, The Plays and Sonnets of William Shakespeare 

Encyclopaedia Britannica, 1952), 608-609. 

** J. Swinton, "Forgetting Whose we are: Theological Reflections on Personhood, Faith and Dementia," 

Journal of Religion, Disability & Health 11, no. 1 (2007): 42. 

™ Oliver W. Sacks, Musicophilia : Tales of Music and the Brain, lstd ed. (New York: Alfred A. Knopf, 

2007), 336. 

xx " John Macnicol, Age Discrimination : An Historical and Contemporary Analysis (Cambridge: 

Cambridge University, 2006), 3. 

xxm AJ Traxler, "Let's Get Gerontologized: Developing a Sensitivity to Aging, the Multi-Purpose Senior 

Center Concept: A Training Manual for Practitioners Working with the Aging," New York (1980): 4. 

XX1V William Fournier and Sarah O'Malley, Age and Grace : Handbook of Programs for the Ministry to the 

Aging (Collegeville, Minn.: Liturgical Press, 1980), 3. 

" Todd D. Nelson, Ageism : Stereotyping and Prejudice Against Older Persons (Cambridge, Mass.: MIT 
Press, 2002), 30-31. 

XXV1 "41. Ode on a Grecian Urn. Keats, John. 1884. the Poetical Works of John Keats," [cited 2008], 
Available from http://www.bartleby.com/126/41.html. 

fXV " Donald M. Chinula, Building King's Beloved Community : Foundations for Pastoral Care and 
Counseling with the Oppressed (Cleveland, Ohio: United Church Press, 1997), 57. 
xxvUi Ibid., 4. 

™ x Fredrica Harris Thompsett, Courageous Incarnation : In Intimacy, Work, Childhood, and Aging 
(Cambridge, Mass.: Cowley Publications, 1993), 62. 

Daniel Homan and Lonni Collins Pratt, Radical Hospitality : Benedict's Way of Love, 1st pbkd ed. 
(Brewster, Mass.: Paraclete Press, 2005), 36. 



101 



XXM Ibid., 36. 

xxxu Paulo Freire, Ana Maria Araujo Freire, and Paulo Freire, Pedagogy of Hope : Reliving Pedagogy of the 

Oppressed (New York: Continuum, 1994), 44. 

XXM " Molloy, Caldwell, and Canadian Medical Association, Alzheimer's Disease, 25. 

™ av Miroslav Volf and Dorothy C. Bass, Practicing Theology : Beliefs and Practices in Christian Life 

(Grand Rapids, Mich.: W.B. EerdmansPub. Co, 2002), 17. 

"^ D. 1. Kertzer, Ritual, Politics, and Power Yale University Press, 1988), 110. 

XXXV! Anglican Church of Canada, The Book of Common Prayer : And Administration of the Sacraments 

and Other Rites and Ceremonies of the Church According to the use of the Anglican Church of Canada : 

Together with the Psalter as it is Appointed to be Said Or Sung in Churches : And the Form and Manner of 

Making, Ordaining and Consecrating of Bishops, Priests and Deacons, 82. 

xxxvii 

xxxvm Johannes Christiaan Hoekendijk and Johannes Christiaan Hoekendijk, The Church Inside Out, 1st 
Britishd ed. (London: SCM Press, 1967), 43-44. 

xxxix 

xl R. Avila, Worship and Politics Orbis Books, 1981), 76. 

"" Ibid, 77 

^ Ibid, 75. 

x,iii Interior Alzheimer Foundation, P.O Box 1423, Stn. 'A Kelowna, B.C. V1Y 7V8, "Alzheimer's Disease - 

the Silent Epidemic," 

xliv Anglican Church of Canada, The Book of Common Prayer : And Administration of the Sacraments and 

Other Rites and Ceremonies of the Church According to the use of the Anglican Church of Canada : 

Together with the Psalter as it is Appointed to be Said Or Sung in Churches : And the Form and Manner of 

Making, Ordaining and Consecrating of Bishops, Priests and Deacons, 82. 

dv Avila, Worship and Politics, 76. 

xlvi Ibid, 76. 

xlv " Hogue, Remembering the Future, Imagining the Past : Story, Ritual, and the Human Brain, 120. 

xlv "' Robert N. McCauley and E. Thomas Lawson, Bringing Ritual to Mind : Psychological Foundations of 

Cultural Forms (Cambridge ; New York: Cambridge University Press, 2002), 67. 

** Ibid, 49 

1 Ph D. Ryan LaMothe, ""I Came so that they may have Life": Amative Space and Faith as Vital Concern," 

The Journal of Pastoral Care and Counselling 61, Nos 1-2, no. Spring-Summer (2007): 11. 

1 Ernst, Hubertus C. A, "On being Human and the Human Image of God," in The Human Image of God 

(Leiden ; Boston: Brill, 2001), 47. 

'"Ibid. 47. 

III Swinton, Forgetting Whose we are: Theological Reflections on Personhood, Faith and Dementia, 42. 

IV Hauerwas, 77k? Retarded and the Criteria for the Human, 130. 

Iv Swinton, Forgetting Whose we are: Theological Reflections on Personhood, Faith and Dementia, 56. 



102 



Bibliography 

"41. Ode on a Grecian Urn. Keats, John. 1884. the Poetical Works of John Keats." [cited 2008]. Available 
from http://www.bartleby.com/126/41.html. 

"About Alzheimer's Disease: Research - Caregiving - Treatment - Publications - Risk Factors - Resources - 
Symptoms - News." [cited 2008], Available from http://www ahaf.org/alzdis/about/adabout.htm. 

"Stages." [cited 2008]. Available from http://www.alz.org/espanol_stages.asp. 

Anglican Church of Canada The Book of Common Prayer : And Administration of the Sacraments and 
Other Rites and Ceremonies of the Church According to the use of the Anglican Church of Canada : 
Together with the Psalter as it is Appointed to be Said Or Sung in Churches : And the Form and 
Manner of Making, Ordaining and Consecrating of Bishops, Priests and Deacons. Toronto: Anglican 
Book Centre, 1962. 

Avila, R. Worship and Politics. Maryknoll, Trans. Alan Neely, New York, Orbis Books, 1977. 

Chinula, Donald M. Building King's Beloved Community : Foundations for Pastoral Care and Counseling 
with the Oppressed. Cleveland, Ohio: United Church Press, 1997. 

Clayton, Jean. The Tiny Red Bathing Suit of Mr. July: Inspiration & Resources for Continuing Care 
Providers. Winfield, B.C., 1997. 

Ernst, Hubertus C. A. "On being Human and the Human Image of God." In The Human Image of God 
Leiden ; Boston: Brill, 2001, 438. 

Fletcher, Joseph "Indicators of Humanhood: A Tentative Profile of Man." The Basting's Center Report, 2 
(5), November, 1972. 

Fournier, William, and Sarah O'Malley. Age and Grace : Handbook of Programs for the Ministry to the 
Aging. Collegeville, Minn.: Liturgical Press, 1980. 

Freire, Paulo, Ana Maria Araujo Freire, and Paulo Freire. Pedagogy of Hope : Reliving Pedagogy of the 
Oppressed. New York: Continuum, 1994. 

Hauerwas, Stanley. "The Retarded and the Criteria for the Human." Journal of Religion, Disability & 
Health 8, no. 3-4 (02 2005): 127-134. 

Hoekendijk, Johannes Christiaan, and Johannes Christiaan Hoekendijk. The Church Inside Out. 1st British 
ed. London: SCM Press, 1967. 

Hogue, David. Remembering the Future, Imagining the Past : Story, Ritual, and the Human Brain. 
Cleveland, Ohio: Pilgrim Press, 2003. 

Homan, Daniel, and Lonni Collins Pratt. Radical Hospitality : Benedict's Way of Love. 1st pbk ed. 
Brewster, Mass.: Paraclete Press, 2005. 

Interior Alzheimer Foundation, P.O Box 1423, Stn. 'A' Kelowna, B.C. VI Y 7V8. "Alzheimer's Disease - 
the Silent Epidemic." . 



103 



Kertzer, D. I. Ritual, Politics, and Power. Yale University Press, 1988. 

Kolb, Bryan, and Ian Q. Whishaw. Fundamentals of Hitman Neuropsychology. 3rd ed New York: 
Freeman, 1990. 

Kuhn, Daniel. Alzheimer's Early Stages : First Steps in Caring and Treatment. Alameda, Calif: Hunter 
House, 1999. 

Macnicol, John. Age Discrimination : An Historical and Contemporary Analysis. Cambridge: Cambridge 
University, 2006. 

McCauley, Robert N., and E. Thomas Lawson. Bringing Ritual to Mind : Psychological Foundations of 
Cultural Forms. Cambridge ; New York: Cambridge University Press, 2002. 

Micks, Marianne H. Our Search for Identity : Humanity in the Image of God. Philadelphia. Fortress Press, 
1982. 

Miles, Margaret Ruth. Fullness of Life : Historical Foundations for a New Asceticism. 1st ed. Philadelphia: 
Westminster Press, 1981. 

Molloy, William, Paul Caldwell, and Canadian Medical Association. Alzheimer's Disease. Toronto: Key 
Porter Books, 1998. 

Nelson, Todd D. Ageism : Stereotyping and Prejudice Against Older Persons. Cambridge, Mass.: MIT 
Press, 2002. 

Ryan LaMothe, Ph D. ""I Came so that they may have Life": Amative Space and Faith as Vital Concern." 
The Journal of Pastoral Care and Counselling 61 , Nos 1 -2, no. Spring-Summer (2007): 7-1 7. 

Sacks, Oliver W. Musicophilia : Tales of Music and the Brain. 1st ed. New York: Alfred A. Knopf, 2007. 

Saint Bishop of Hippo Augustine, and G. Wills. Saint Augustine's Memory. Viking, 2002. 

Shakespeare, W., W. G. Clarke, and W. A. Wright. The Plays and Sonnets of William Shakespeare. 
Encyclopaedia Britannica, 1952. 

Swinton, J. "Forgetting Whose we are: Theological Reflections on Personhood, Faith and Dementia." 
Journal of Religion, Disability & Health 11, no. 1 (2007): 37-63. 

Thompsett, Fredrica Harris. Courageous Incarnation : In Intimacy, Work, Childhood, and Aging. 
Cambridge, Mass.: Cowley Publications, 1993. 

Traxler, AJ. "Let's Get Gerontologized: Developing a Sensitivity to Aging, the Multi-Purpose Senior Center 
Concept: A Training Manual for Practitioners Working with the Aging." New York (1980). 

Volf, Miroslav, and Dorothy C. Bass. Practicing Theology : Beliefs and Practices in Christian Life. Grand 
Rapids, Mich.: W.B. EerdmansPub. Co., 2002. 



104 



SURVEY QUESTIONAIRE 

1. What is the size of your present congregation? (How many names are on your present 
parish list)? 

2. How many services do you have during the week? 

3. Does your congregation have: (check all that apply) 

a) Lay Assistants 

b) Curate 

c) Associate / Retired Clergy 

d) Parish Nurses 

4. In your present ministerial context, how many Care Home Facilities do you presently 
have pastoral oversight? 

5. Of the people in care homes, how many do you have a direct personal ministry to? i.e. 
Parishioners? 

6. When offering pastoral ministry to residents in care home facilities, do you: (check all 
that apply) 

a) Offer a hymn sing 



b) Offer Holy Communion 

c) Offer Scripture readings 



d) Offer other devotional material (Please specify 



7. If you offer Holy Communion in care home facilities, which form of service do you 
use? 

a) The Book of Common Prayer 



b) The Book of Alternative Services 

c) Another alternative form (please specify) 

d) All of the above 

8. If you offer a communion service, is it your practice to: 
a) Use Reserve Sacrament 



b) Consecrate the Elements during the Service 



9. What are your reasons for choosing to consecrate or not? 



105 



10. Do you offer parts of the service where the congregation, in the Care Home Facility, 
can participate in? 

Yes No 



11. When you offer pastoral ministry in Care Home Facilities, do you wear vestments? 
Yes No 

12. If yes, on which occasion would you wear vestments? 

13. If yes, which vestments do you wear? (Please check all that apply) 
Alb Chasuble Surplice 

Stole Cassock Maniple 

1 4. Do you use hymns during a service? Yes No 

15. If yes, what is your normal practice? 

a) Contemporary hymns from the 1998 "Common Praise". 

b) Older hymns from the 1939 "Book of Common Praise" 

c) Another source, i.e. Gospel hymns (please specify) 



16. How many people with Alzheimer's Disease, or other forms of dementia have you 
ministered to? 

17. Do any of the persons who, to your knowledge who have Alzheimer's Disease or 
other forms of dementia participate in the liturgy? 

a) Yes 

b)No 



c) If yes, how do they participate? 



18. Do you find any response with persons who have Alzheimer's Disease and other 
forms of dementia with the use or non use of vestments? 

a) Yes 

b)No 



c) Unsure 



19. What physical signs of your ministry do you bring with you whenever you offer 
pastoral care to persons with Alzheimer's Disease and dementia? (Check all that apply) 

a) Bible 



b) Communion set 

c) Wearing clerical attire 

d) Other (please specify_ 



20. Do you find this helps? Please explain 



106 



21. In your experience, do the residents who to your knowledge have Alzheimer's 
Disease and other forms of dementia, ever join in with any of the prayers or responses 
during a service? 



22. Have you ever noticed any specific responses in persons with Alzheimer's Disease 
and other forms of dementia whenever a familiar hymn is sung? Please explain 



23. What hymns, to your knowledge, elicit the most connection with people that you 
minister to who have Alzheimer's Disease and other forms of dementia? 



24. In your opinion, how do Alzheimer and dementia residents respond when the 
Eucharist is offered at a service? 

a) There is a noticeable connection 

b) There is less of a connection 



c) There is no discernible difference 



25. Are you aware of any additional services, rites, hymns or ministry tools that you have 
noticed which increase the connection that you have with persons with Alzheimer's 
Disease and dementia? Please specify. 



26. When ministering to persons with Alzheimer's Disease and dementia, do you ever 
establish any physical contact (such as the touch of a human hand) with the person? 



a) Yes 
b)No~ 



28. In your opinion, does this make a noticeable impact on your visit with that person? 



29. Where do you find the area for doing ministry to Alzheimer's persons most effective? 

a) Dining room converted into a worship space 

b) An open meeting area such as a living room or tv room 

c) A designated chapel 

d) One on One 

d) Other space (please specify) 



107 



30. Why is the area that you have chosen most effective? (Please comment) 



31. Have you noticed any specific gifts that the inclusion of a person with Alzheimer's 
Disease may have brought to your present congregation? If so, what might they be? 



32. What challenges, if any, have you found in doing any form of ministry with persons 
who suffer from Alzheimer's Disease and dementia? 



33. Over all, how would you rate your effectiveness in doing ministry with persons who 
have Alzheimer's Disease and other forms of dementia? 

a) Very effective 

b) Moderately effective 

c) Not very effective 



34. On a scale of 1 to 10, what is your comfort level when you offer ministry to persons 
with Alzheimer's Disease or other forms of ministry? (One = very comfortable, 10 = very 
uncomfortable) 



35. Would a model of ministry be helpful in increasing your effectiveness in this area? 
Please comment. 



36. Would a workshop in this area of pastoral ministry be helpful if one were provided? 



108 



c/3 

£ 

£ 
o 

U 



= 

s 
O 

4> 



=5 



# o 

<Zi 

a 






o 

t+H 

0) 

v- 
e3 
O 

13 

c 

■<-> 
X 



o 



§ 

o 

S 

oc 
c • 

^ , 

J3 ! 

c 

i- 



C/3 

u 

o 

e 
<u 

<D 

u. 

<s> 
Eh 

o 

c 

<N 

T3 

C 

a 

<D 

e 

o 

43 

CD 

03 
O 

<D 

a 
O 



00 



<L> •>-. 

■° -3 
X) C 

< ° 

(u c 

£ fi 

CO _S 

5 u ; 

s § ' 
3 "2 >- 



A 



A 



e fc: 4» 

§ o a 

- £ <* 

(D ,_, <U 

C o c 

o tfi o 

(25 (n J5 

A A A A 



N 

co 



<D 

o 

"E 

CO 



CO 



o 

<D 

8 
o 



00 



3 

43 

(73 

+ 

o 
n- 

"03 
d 
o 

-3 

T3 

t/i 

t*N (D 

"^43 

<d +* 

O JO 

.£ w 

7* <d 

t§ 

§ 43 
1/3 <D 

r? «* 

£2 



A A 



•— 
e3 

u 

<L> 

"3. 
o 
<d 

Oh 

wi 



2 
"o 

■*-> 
o 

c 

en 

<L> 

C 

o 

<+H 

<L> 



N -5 

03 -tJ 



OhWU 

AAA 



\o 



o> 



v© .» 






T3 
(D 

"C 
X) 

<: 

Oh 

u 

PQ 



<u is 
</) o 



Oh 

u 



IX ffl 



T3 
u 

O 



OO 



o 

1J 



§ 

1-. 
o 
u 

c 

o 

o 



43 

o 

s 

c 

c 
o 
o 

03 

<u 

T3 

<u 
8 

c3 
1— 
O 
e3 

WD 

<D 

<D 



A A A A 



A 




A A 



4^1 

o 

o 

m 



a 

*— 
o 

03 

era 

00 



c 
o 

o3 

«u 

Wh 

Vh 

3» 
O 

•— 
03 
■«-» 
03 



I 

t-H 

o 

c 
o 

O 



On 



00 

O 
O 

43 
O 



= 

JO 
*£ 

a 

4> 



a 




<u 

I— 



r- 


o 

X 




X 

o 


1 




W- 


co 




3 
X 
O 


o 




CD 


"S 




-* 


o. 


oo 


•"* 


CO 


•*-» 


t-l 
O 

i 


w- 

£ 


> 
u 


co 


i> 


(1) 


E 


X 


w. 


N 


1) 


<L> 
CD 

to 
h-» 


3 


X 
O 




a 


£ 


s 

x 


X 


CD 


to 


•»-» 


03 




d) 


X 




£| 




% 


>, 




T3 


a> 


_^ 


to 


X 

•a 


o, 

X 


d 
E 


X 


*-< 


CO 


+-» 


ri 


U 


(-H 


•— ( 


.> 



d 
<a 

a> 

a 

<u 

x 



-WH 
3 
03 

a> 

X) 

o 

to 

T3 
3 
«1 

-o 

c 

O 

Wh 

03 

O 
DO 



>-> <D 

35 X) 

.2 £ 

O <L> 

K, £ 

<C 03 

*«3 d 

co ■♦-» 

3 X 

« y 

S § 

co *^ 

CD O 

> +■* 

c+_ <U 

CD o 

22 to 

3 & 

^ | 

d •— 



CD 



A A A 



£ 7, 

2 2 

2 co 

Wh s» 

a.- 

2 8 

-« •*> 

8.53 

O.X 

<u S 
£ <d 

«J X 

co -*-» 

>> o 

c d 

CD tU 

c & 
U S 

A 



-t- PQ 

■9 T3 
O CD 

o,&> 

"c3 Oh 

«2 PQ 



< 

PQ 
o 



Oh 

u 

ffl 



CO 

CD 
| 

<u 

g 

O 

CO 

M 
O 
O 

X 



>1 

X 

co' 

<D 



A- 1 ^ 

o o 
o o 

m cq 



W- I 5-4 r/5 

<L> CD 
^ >^0h 

Ph Oh PQ 



A A A A 



1 


<L> 




43 


CO 


■»-> 


d 


CD 


o 


Vh 


r*i 


,© 


g 


%3 

a> 


o 


X) 


o 

CO 
CO 


CO 

C 


03 


o 








•*-> 


rn 


o 


C 


eS 



is 

co 3 

•- * a) 

•^ E 
x o 



u 



CO 

•8 

CO 

U 

4>i 

•2 

■*-• 

^-v 3 

IS 



>vD 



«3 



Oh 
CO 

O 
-3 
03 



•s 

3 
03 



«J - 



as 



3 

.« 03 



o 

'G 

Oh 



o 



<D 

■♦-> 

i2 

13 

»- 

u 

CD 

3 



S « a S 1r5 



3 1 

^ to 



"55 o 
.— "^ 

* J 

3 > 

CD "3 
S 3 

3 «J 

S3 E 

Oh—I 

3 -3 

ao 

<D co "S u 

-3 03 > £2 

.3 &0 -i 3 

« 3 X> O 

P -3 (D O 

1 1 1 o 

CD "S. ^ _l C 3 

X rr <d cd 



3 

CD 

-o 

3 
03 

o 

>» 

CD 

-3 



^s I-? 



(D 
co 

p 3 



o 

3 C 

CO CO 

M ^_* 

CD O 
>% CD 

g X? 

Oh O 

1- — 

03 aj 

S' 'to 

m2 J? 



CO 

O 

+-> 

Wh 
CD 

3 

CD 

X 

-o 

3 
O 

Oh 
CO 
CD 



£ 

CD 



CD 
X! O 
1 3^ 

g ci> 

3 «3 



S.8 

> g 1 

CD Oh 

H-> CD 

O co 

H-H D 

"3 .53 

"S >"H 

O CD 

E o- 

■ 22 w 

?*~> CO _- 

to O, 



CD 



o 

co 

1- 

H— 



o 

X 

£ 

CO 

"co 
3 
O 

'3 
o 

CD 



gH;a g . 



/H-S CD 

<r> co 

13 jg 

GO 

o,^ 



<D 

Wh 
03 

3 
O 



5b 2 

-.-. S 
■- 3 



CD 



03 



Q PQ 



o 3 
*- cd 2 

l-H ^^ 3 

3 cd d 
O N to 

CO Q> > 

5 ° rS 
03 o 3 

CD V-c > 

■° >> CD 
CD 3-; > 
Q0X O 

-3 ""' X 
3 of tsJ 

T> CD CO 



o 
jj 

t- 
c2 

bo 

3 

o cr 

CD w 
03 co 



3 
CD 

"■£ 

0h 



A AA AAA AAA A 



X5 



r-H r^ 



CO 

CO 

CD 


o 

< 

_CD 

X 

s 

3 

C+-I 

O 

Wh 
CD 

03 

Wh 

Oh 

3" 
O 



■a 

o 
U 

Cm 
O 

Wh 

CD 
?^ 
03 



CD 



VO 



03 



82 w 

CD u 
>H 00 



Wh 

CD 
>^ 

03 

Wh 
Oh 
CM 

^ "3 

Wh CD 

O CD 

o « 

*d "3 

3 co 



<T) CO 



< 



CD 



■T5 *^ CD 

Wh CO o CO 
•=J CD -5 CD 



to 



> Z >• 



A A A A A A 



CO 



CO 

Cj- 

"S 
X 
co 
X 

3 .5 
c3 03 

3 "E, 
O X 
>, CD 

O CD 

°"# 

(N Oh 



3 

■8 3 

CD O 
CD ■— i 

cj > »i 

CD < 2 



co 
3 
O 

Oh 

co 



CD 

'C X 

o- g 

CD CO CD 

3 3^ 

O -O ° 

>-> •-; co 

CO Wh 

3 CD CD 

• CD 03 

< — I r-l Wh 

<M h3 Oh 




.O .22 0* 

~ 2 y -o 

r" W -» C 

£ Jb w S 

A 



Q M^ SL* 



AAA A 



^ os o 

~ H g 

2 ° >. 

.& w z 

.2 2> a. 

€ ■§ c 

o--s 8 

-o- *? ft 



a> 



c 


M 


3 


03 


oo 
on 


s 


<L> 


T3 


G 


C 


g 


03 


o3 


X! 


£ 


+■* 


aJ 


£ 




b0 


+-» 


G fT~ 


rrt 


-G »r> 


« 


DO^ 


feb 


c r-. 

00 T_ * 


-o 
d 


o % 


h-H 


< 00 



)- u 



o — < s 



Q O 



AAAA AAAA 



> 
o 



c 

*a 

c3 
O 

43 



00 

00 

< 

<L> 
oo 

00 

U 

3 

tf 

a 
<u 
K 



M a, 

2— O 



oo 

T3 
O 

O 
43 

T3 



■^1 

- o .5 



G ?S 



1) 
u 



00 

c 

1 

X 

(L> 



T3 

c 

09 

O 

!— 

03 

u 

03 



0) 

£ 

£ 



o 

>— > 

£ 

> 

o 

o 
43 2 

■*-» 43 
i-> <-» 

c3 a> 

a £ 

c D 
< H 



- o 
c r u 

2 1 w> 

<L> Oh -5 

* 8 I 

O < < 
>,-£ U 
> O oo 

<uT X 

•3 5 

£° 

« o 

o w 
p» O 



a> 
> 

o 
_) 

00 

3 

00 



00 

n*.2 I 
"2 U 
o 

oo 



O 



'S 



00 

c3 

£ 

oo 



o 



i 

c3 

00 

i 

£ 

J3 



C3 
oo 

oo 
03 



> 

a> 
o 

oo" 

C 

§ 



O 
<u 

H 

•o 

a 

03 

"<u 

g 

00 

> 

O 

00 

=3 
oo 



(L) B 

c a> 

^ 6b 

'5 ^ 

> 00 

jc, a> 

< -5 



u^ tc 



^||Q^ 



2 SG 



U U T3 W h 



Big 

00 ^^ 
00 

U 

C 

o 



-B 2 e 



t: 

03 

w 

c 
o 



1- 

o 2 

§ ° 

03 a 



2 c 

03 s_ 

O 2 

§ "8 

•c S 

o >, 

^~» n w 

O -O 43 

r-H C +-> 

^ £ 3 

5 «-i 93 

« O 4= 



P § 

*5 

.22 o 

oo C 

00 

03 .22 
A3 (D 

8* 32 

a c 

<D O 
03 

OO {^ 

1) M 

X! C 

' "1 

03 
U 

s 
.2 i 

■a o 

C oo 

<N 
3 






S tin 



*— I • — 
+-» 

oo o> 

US 60 

T3 o 

•*-• i-i 

C c© 
O 



00 

oo 
O 

O 

T3 

*L 
6B 



c 
u 

<u 

u ( 
o 

T3 



C 



AAA A 



A A A A A 



A 



oo 
oo 


H 

o3 


C 


•~j 


O 

a. 


£ 


00 

(1) 


eg 


■— 


03 




^ 


(13 


^ 


a, 


00 


00 


C 


>. 


o 

00 


c 


'■*- r~ 


03 


8.1 




• S X5 



<D 








c 




*-» 


o 






00 




O 


V- 




•*-H 


<L> 




U 


iX 




00 


43 




C 


+-> 




£ 


^ 




43 


o 




+-> 






<Tt 


+-• 




1 


C1J 


< 


§ 


+3 


m" 


o 


■> 



<N O 



oo 

c 
o 
a. 

OO 

a> 

M 
^* 



00 



I 
1 

O 



G 
C 

> 
g, 



3 ■ 
o ' 



"> £T 
•3 C- 

!•§ 

.22 £ 

c 3 
o a> 

>,* 

* o 

o S2 
+- a, » 

ca O-jS 

" c 

*T3 co '+3 
«* «> ° 

co C 

| 2 5 

!» 3 

J> c s 
op o 5 

G - '8 B 
a ' 

O (3 

o - 

CO "2 43 

^ 33 

(L> -f* '" , 

J3 9 o 

** g « 

00 o * 

CO 



J3 
O 



43 
O 

8 



to 



Oh <** 

<D 00 >? 

s ^ 
s ° 



43 

H 



co - J3 co 
>H .S ^ 



A A A 



en 

& 

3 
S 




AAAAA AAAA AA AA AAAAA 



CQ « 



A A A A 





<D 








4> 


SD 








o 






B 


£ 




G 


g 


T3 




(D 


o 


lx 




CO 

Ph 


o> 


U 








b0 
3 

o 














C3 

l-H 

2 

CO 


> 


(N 


•S 

e 


a* 


1 


CO 


g 

1> 


c 


*- 


^4 

J— < 


"O 


co 
O 


£3 
X) 


O 




o 


co 


<u 


^ 


s 

1) 


CO 


U 




■5 


T3 
O 


"e3 


2 

13 


•a 

i 


H3 


o 

CO 

est 


53 
'5 


CO 
CO 


c3 


O 


-*-• 






d 




3 

d 
o 




0> 

■c 

u 


O 


TJ 


"3 


X 


13 


U 


o 


<u 


s 

o 

(X, 


J3 

o 
o 


G 


oo" £ 

T3 O 


>> 


G 


<L> 


o 


O 


CO 


'C "O 


1 

1 


1 


3 
d 
T3 


C3 <o 
o £ 

■a 9 


45 


ess 


3 
o 


o S3 
£ 3 


o 


*> M 


H D 


3 


CO M 


■^ 


3 C 




C 
c3 to 




O «J 


c 


«'C 


o 


c o ^- , 


• ^* 


^ «SJ 


CO 


O SO w 


-«-» 






00 


"3 a) 
3 cS 


3 


00 "-- >x 


1 




CO 


■3 i t7? 


c/f 


* S! 


£ 


co <g -d 

J2 o .5 


£ 




A 


A 


A 


A A 








CO 








+"» 








d 








u 








o 








o 








»-. 








<D 








43 








■*-» 








o 



SO 



CO 

c 
o 

•s 

CO 

3 

O 

>. 

£ 

3 

0) 



_J 


E 

i 

l/> 

1 

CO* 


co 
o 
"55 

XI 
CD 


co 

c 


TO 

c 


CO 

c 


co 
o 
*to 

-Q 
CO 


CO 

c 


o 

8 

CO 

CO 
o 
cu 
o 
"55 

3 
CO 


co 

o 
"55 


CO 

o 
"55 


XI 
CO 

co" 
o 
"55 


CO 

3 

■8 

co 

X 

o 
co" 
o 
"55 

Xl" 
CO 


CO 

c 


CO 

o 
"55 
xt" 

CD 


CD 

c 


o 

o 

I 

to 
o 

co" 
o 
"85 


CO 

o 
"55 


C0 
3 
X) 

to 

CD 

sz 
o 

to" 

•§ 

xf 
CO 


CO 

c 


.2 
o 
o 


CO 

c 


CO 

o 
"5! 

X)" 
CD 


CD 

c 


to 
o 
"55 

Xl" 

CO 


CO 

o 
"55 


CO 

o 
"55 


CO 

c 


to 
o 
"55 


CD 

c 


co 
o 
"55 

Xl" 
CD 


CO 

o 
"55 


ili 


J2 

c 

i 

> 


(0 

> 


co 


CO 

c 


o 

c 


to 

co 

> 


o 


CO 
CO 

> 


o 

£Z 


CO 
CO 

>■ 


co 

<0 

>■ 


o 

c 


o 

c 


to 

CO 

>■ 


o 

c 


to 

CO 

>■ 


to 

CO 

> 


o 

c 


o 

c 


o 

c 


CO 

c 


to 
CO 

> 


o 

c 


to 
CO 

>■ 


to 
CO 

5- 


CO 

to 

> 


CO 


to 

CO 


'c 


to 
CO 

>■ 


to 

CD 

> 


— > 


c 
c 
o 
© 


co 


<** 


(0 


CO 
0) 

> 


(0 
CD 

> 


CO 


CO 

CO 

> 


CO 
CO 

> 


co 
co 

>■ 


CO 

CO 

•> 


to 
to 


to 

>■ 


o 


CO 

co 

>■ 


o 


o 

c 


CO 

c 


o 

c 


CO 
CO 

> 


co 


o 

c 


to 
CO 

>■ 


to 

co 


10 

CO 

> 


to 

to 

> 


CO 


CO 

co 

> 


o 

c 


to 
co 

> 


to 
co 

> 


- 


c 

I 

2 
u 
co 
(0 

CO 


XI 


ID 


co 

c 


CO 


.a 


CO 


CO 


xi 
co" 


XI 
co" 


X) 


XI 


XI 


Xl_ 

co" 


XI 
CD 


XI 


XI 


XI 


XI 


X) 


CD 


XI 


Xl 


Xl 


Xl_ 

co" 


CO 


CO 

c 


CO 


X) 


XI 

co" 


XI 


I 


8 
GO 


CO 


0] 

c 


CD 

C 


CO 


CO* 


CO 


CO 


CD 


X) 


CO 


o 


■o 


CO 


XI 

co 


o 


CD 


XI 


CO 


CO 

c 


CO 

c 


CD 


CD 


CD 


x> 


CD 


CO 

c 


XI 


XI 


o] 

x» 

CD 


CO 


o 


*K 

c 

i 


o" 
CO* 


CO 

c 


CO 

c 


•a 
o" 
xf 
co" 


o 
x> 
co" 


o 

XJ 
CO* 


XI 


Xl_ 

CD* 


o 
xt~ 


o 
xT 
co" 


XI 


o 

X) 


CO 


o 
xf 
co" 


o" 
XI 


XI 
CD* 


XI 


u 

xT 


-a 

xT 
co" 


CD 

c 


o 

XI 

co" 


xT 
co" 


CJ 

xT 
co" 


CJ 
Xl" 


■a 

Xl" 

co" 


CD 

c 


XI 


Xl] 

co" 


o 
xi 

CO 


-a 
c[ 

Xl" 

co" 


U- 


2 
n 
O 

e 

0) 

a 

8 

a. 


ID 


(0 

c 


o 


m 

CO 


to 


- 


o 


co 


- 


■* 


CM 


CM 


o 

Xl" 

co" 


o 

CM 


CM 


CM 


r^ 


- 


to 


CO 

c 


to 

CD 

c 


CO 


CM 


o 


CM 


CO 

c 


CO 


o 


o 


m 


LU 


£ 

<3 

0) 

E 
o 

I 


«- 


o 


o 


CO 


-ti- 


CM 


co 


o 


o 


<o 


CM 


o 


CM 
CM 


to 


■* 


CO 


o 


■* 


CM 


CO 

c 


CO 


co 


CO 


■* 


TJ" 


CO 

c 


-3- 


- 


co 


CM 


Q 


a 
I 

CO* 


o 
to 


o 


CO 


o 

xi" 


o 

co" 


o 

x" 
co" 


o 


■a 
o" 
xi 

co" 


o 
co" 


o" 
xT 
co" 


co" 


o 
co" 


CM 


o 

co" 


CO 

c 


o 


CJ 
CO* 


o 

CD* 


o 


co" 


o 


o 
Xl" 

ro" 


o 

xT 

CD* 


CJ_ 

co" 


o 

CD 


CD 

c 


Xl^ 

co" 


CD 


o" 

xT 
co" 


CJ_ 

cd" 


O 


10 

a 

o 

E 

(0 
cm 


co 


- 


CM 


■* 


CD 


m 


CM 


■* 


CM 


CO 

c 


*- 


lO 
CM 


CO 


CO 


*- 


in 

CM 
CO 


in 

CO 


CO 


CO 


CM 


CO 


CO 


co 

CM 


m 

CM 
CM 


- 


CO 

c 


CM 


- 


■* 


CO 


CD 


N 


o 
o 


o 


CO 


o 

in 


<D 
CD 


o 

CO 


o 
o 


o 

If) 

CM 


o 
o 


CO 

c 


CM 

-* 


o 

CM 


o 

m 


o 

CM 

co 


o 
o 
co 


in 

in 

CM 


o 
o 
co 


CD 


CO 

o 


o 

co 


o 


o 

o 

CM 


o 
to 


o 
o 

CM 


in 

CO 
CM 


CD 

c 


o 
in 




o 
o 


o 
o 


< 


d 

z 

o 


- 


CM 


co 


tt 


If) 


CO 


r- 


CO 


a> 


o 


-*■ 


CM 


CO 


-*• 


m 


CO 


f~ 


00 


<y> 


o 

CM 


CM 


CM 
CM 


CO 

CM 


CM 


m 

CM 


to 

CM 


CM 


co 

CM 


CM 


o 
co 




- 


(M 


co 


"* 


lO 


CO 


r-- 


CO 


O) 


o 


— 


CM 


CO 


■"3- 


in 


CO 


c~- 


co 


o> 


o 

CM 


CM 


CM 
CM 


co 

CM 


CM 


in 

CM 


CD 
CM 


CM 


CO 
CM 


CM 


o 
co 


co 



10 

c 
o 

■s 

CO 

3 

O 

>< 

<D 

£ 

3 



x 


a 


x: 

CA 

% 

<© 


(0 

0) 

>■ 


CA 

co 

>■ 


O 


CA 

a> 

> 


I 


10 
CO 

> 


> 

Xl 
CO 

Xl 

o 

Q 


CA 

CO 

>■ 


CO 


CA 

CO 

> 


(A 
CO 


(0 

> 
JP. 

5 


(0 


ro 


o 

c 


0) 

CO 

> 


CA 

a> 

> 


CA 

CO 

> 


ro 

c 


ro 

c 


CA 


!8 

> 


CO 
CO 

E 


CA 

<0 

> 


CA 

CO 

> 


CO 

cz 


CO 
XJ 

> 
ro 

E 


CA 

> 


co 

c 


2 

> 


5 


<o 


in 


co 


CM 


00 


CM 


m 


m 


CM 


- 


CO 


- 


CO 


CM 


m 


m 


- 


CO 


CD 


- 


CO 


- 


oo 


CM 


- 


oo 


- 


CO 


CO 


- 


- 


> 


1 

CO 


XI 


CO 


-O 


CO 

c 


XI 


Xl 


XI 


XI 


(0 


Xl 


XI 


Xl 


ro 


Xl 


o 


o 


o 

XJ 

co 


XI 


XI 


ro 

c 


X) 


XI 


XI 


XI 


o 


CO 


Xl 


XI 


ra 


JO 

CO" 


Z> 


e 

o 
o> 

CM 


■o 


(0 


CO 

c 


CO 


d 


o 

Xl" 


xT 


■o 


cj" 


o 


d 


o 
x[ 
co" 


•a 


CO 


T3 

d 


XI 


T3 


XI 


q 

6 

Xl" 


ro 


XI 


d 


q 
ro" 


Xl" 


"O 


CO 

c 


Xl 


ro 


T3 
d 
XJ 

co" 


o" 
XJ 

ro" 


H 


o 

8 


CD 


CO 


CD 


CO 

c 


CO 


ro 


CO 


(0 


CO 


(0 


CO 


CO 


CO 


CO 


ro 


CO 


CO 


ro 


ro 


CO 

c 


CO 


ro 


ro 


ro 


ro 


ro 


ro 


ro 


co 


CO 


co 


0) 

CA 

c 

g 

a: 

CM 


O 


XI 


CO 


CO 


CO 

c 


CO 


CO 

c 


XI 


CO 


CO 


CO 


XI 


CO 


ro 


ro 


XI 


CO 

c 


XI 


ro 


ro 

c 


co 


ro 


ro 

c 


CO 


ro 


CO 

C 


ro 


ro 


ro 


ro 


ir 


IA 

c 
« 


d 

Xl" 


O 


CJ 

xi" 

CD 


xT 


q 

o" 

Xl" 

co" 


q 
d 

Xl" 

ro" 


q 
d 

xj 

<o" 


XJ 
ro' 


o 

Xl" 

co" 


CO 

c 


T3 

xT 


q 

ro" 


o 
xj" 
ro" 


o 
xj 
co" 


XI 
CO 


-q 
d 
xT 
ro" 


u 

XJ 

co" 


o 
XJ 

co" 


o 

Xl" 

co" 


q 
xT 


o 
xi 

CO 


Xl" 

ro" 


d 


q 

o" 

XJ 

ro" 


d~ 
x>" 


ro 

c 


q 
6 
xT 
ro" 


o 
XJ 

ro" 


o 
xj" 
ro" 


Xj" 

co" 


o 


(A 

£ 

V) 

£ 

oo" 


05 


CA 

> 


(A 

4) 

> 


o 


(A 
CO 

> 


o 


(A 

CO 

>■ 


o 


o 


CO 

c 


to 

CO 

> 


o 

c 


o 


o 


o 

c 


o 

c: 


CJ 


o 


o 


ro 

c 


o 


o 


IA 
CO 

> 


o 


CA 
CO 

>< 


ro 

c 


o 


o 


CA 

CO 

> 


XI 


Q. 


IA 

i 

a 
'o 

r 
3 


(0 


(0 


(A 
CO 
> 


(A 

co 

> 


(A 
CO 

> 


(A 
CO 

> 


(A 
CO 

> 


IA 
CO 

> 


ca 

CO 

> 


CO 

c 


(A 
CO 

>■ 


(A 

CO 

> 


o 


(A 
CO 

> 


o 

c 


CA 

CO 

> 


IA 
CO 

> 


CA 

CO 

> 


CA 

CO 

> 


ro 

c 


CA 
CO 

> 


CA 
CO 

> 


* 


CA 
CO 

> 


ro 


ro 

c 


ro 


o 

c 


CA 

CO 


XI 


o 


B 

oj 

Xl 

E 

3 
E 

to 


co 




CM 


o 


CM 


CM 


CM 


CM 


CD 


CO 

c 


o 


>■ 

c 

CO 

E 


■* 


in 


m 
in 


ro 

c 


■* 


CA 

c 

CO 
N 

o 
■o 


o 
co 


CO 

c 


in 

CM 


- 


CM 


O 


ro 

cz 


ro 


ro 

c 


■* 


ro 

c 


co 


z 


£ 

0) 

E 
£ 


XJ 


(0 

c 


CO 

c 


o 


CJ 


CJ 


CO 

c 


(0 

c 


CJ 

xT 


o 


o 


XI 


CO 

c 


XI 


o 


Xl 


XI 


ro 

c 


o 

xT 


ro 

c 


o 


o 


ro 

c 


o 


ro 

c 


ro 

c 


o 


o 
xT 


o 


o 


2 


IA 

c 

E 

> 


ca 


CO 


CO 

c 


(A 
CO 




(A 
CO 

9N 


o 


o 

c 


(A 
CO 


(A 

CO 

>> 


(A 
CO 

> 


<A 

CO 

>- 


o 


CA 

CO 

> 


CA 
CO 


CA 
CO 


CA 
CO 


o 


CA 
CO 

>• 


ro 
c 


CA 

CO 


CA 
CO 

> 


CA 
CO 

>• 


CA 

OJ 

> 


ro 

c 


ro 

c 


CA 
CO 

>■ 


CA 
CO 

>• 


> 


CA 

> 


< 


d 

z 

o 


- 


CM 


co 


■* 


in 


CO 


r- 


00 


o> 


o 


- 


CM 


co 


•«t 


m 


CO 


t-~ 


CX3 


a> 


o 

CM 


CM 


CM 
CM 


co 

CM 


•* 

CM 


m 

CM 


CD 
CN 


CNJ 


00 
CM 


OJ 
CM 


o 

CO 




- 


CM 


CO 


■* 


in 


CO 


l*~ 


oo 


CJ) 


o 


*- 


CM 


CO 


f 


in 


(D 


r- 


CO 


a> 


o 

CM 


CM 


CM 
CM 


CO 
CM 


CM 


m 

CM 


CD 
CM 


1^- 
CNJ 


oo 

CM 


CM 


O 

CO 


ro 



sr/o - on 





DATE DUE 




















































































































































GAYLORD 






PRINTED IN USA 



EDS/WESTON JESUIT LIBRARY 



0135 00264 7186